500 1000 local 50052 myrecords@themedicalcityiloilo.com

REQUEST MEDICAL RECORDS
Please fill the form accurately if you want to request for copies of your medical records.

Request for a Medical Record
Please indicate Last Name
Please indicate First Name
Age
Address
MM/DD/YYYY
MM/DD/YYYY
Please check document/s to be requested
Please bring a letter from the attending physician requesting for the records
(09XXXXXXXXX)
Sending

Information contained in a medical record is confidential. All requests for release of medical records must be accompanied by an authorization form.

The Authorization Form will be required from the following:

  • Patient (if the requester is not the patient him/herself)
  • Attending Physician (for requests needing a certified true copy of Medical Abstract, OR Tech & OR Record)

 *For patients below 18 years old, the authorized guardian must sign the Authorization Form.

For a copy of the authorization form please click here to download.

Please click the link for more information on How to Receive Medical Records. Our representatives will get back to you within 24 hours except during Weekends and Holidays.

Thank you!

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500 1000 local 500 52