If you are covered under insurance kindly intimate your insurance provider in advance before your visit the hospital so that your requirements are met. If your service provider does give you an insurance cover, your benefits would be reduced , leaving you responsible to paying the bill for all your hospital expenses. Patients who are covered by Medicare will need to fill in the Medicare form at the time of registration.
We at ARC treat patients records with high priority and confidentiality. To obtain your medical records after you have completed your treatment at ARC. Please follow the simple steps below. If you have any questions please feel free to contact just atxxxxxxxxx Fill in the authorization form:
- The valididty of the authrorization form is valid for 12 months on the date of signing, if there is no expiration date or no returned information from the patient.
- The form must be filled with all accurate information, failure to caputre all the details on the form will result in delay of obtaining the medical reords, these forms cannot be processed
Information requested on behalf of the patient either family/or otherwise
- Authorization is required on behalf of the patient
- Letter of authorization, guardianship papers , power of attorney papers & other legal documents
- Signature of the patient's representative and date
- Relationship of representative to the patient
SUBMITTING THE FORM
Complete forms will be accepted with all information captured accurately, irrelevant details are not accepted .Please remember that incomplete forms cannot be processed and will be returned to the requester.
Please send the authorization form by to the no xxxxx or email to the add xxxxxxx