The Form For Requesting Medical Records is a essential document used in Saudi Arabian healthcare facilities to process and manage patient requests for medical record access. This standardized form ensures compliance with Saudi healthcare regulations, including the Saudi Healthcare Law (Royal Decree No. M/11) and Personal Data Protection Law (PDPL), while providing a structured approach to handling sensitive medical information. The form is designed to capture all necessary patient information, specific record requests, authorization details, and identity verification requirements. It serves as a crucial tool for healthcare providers to maintain proper documentation of record requests while protecting patient privacy rights and ensuring appropriate access to medical information. The document is particularly relevant in cases where patients need their medical records for continuing care, legal purposes, insurance claims, or personal records.
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1. Patient Information: Essential demographic details including full name (in Arabic and English), national ID/Iqama number, date of birth, contact information, and medical record number
2. Records Request Details: Specific information about the medical records being requested, including date range, type of records, and facility/provider names
3. Purpose of Request: Declaration of the reason for requesting medical records (e.g., continuing care, legal purposes, personal records)
4. Authorization Statement: Legal statement authorizing the release of medical records, including reference to Saudi healthcare laws and patient privacy rights
5. Identity Verification: Requirements for proving the identity of the requestor, including acceptable forms of ID
6. Delivery Preferences: Preferred method of receiving the medical records (electronic/physical) and delivery details
1. Third Party Authorization: Additional section when records are being requested by someone other than the patient (guardian, legal representative, or authorized person)
2. Urgent Request Declaration: Special section for expedited processing of urgent medical record requests, requiring justification
3. International Transfer Details: Additional information required when records need to be sent outside Saudi Arabia
4. Fee Acknowledgment: Section detailing any applicable fees and payment methods, if the facility charges for medical records
5. Specific Exclusions: Section where patient can specify any particular records they do NOT want included in the request
1. ID Requirements Checklist: List of acceptable identification documents and requirements for different types of requestors
2. Fee Schedule: Detailed breakdown of any applicable fees for different types of medical records and processing times
3. Record Types Guide: Comprehensive list of different types of medical records available for request
4. Processing Timeframes: Standard processing times for different types of requests and conditions for expedited processing
Relevant legal definitions
Clauses
Relevant Industries
Healthcare
Medical Administration
Healthcare Information Technology
Legal Services
Insurance
Public Health
Private Healthcare
Government Healthcare Services
Relevant Teams
Medical Records
Health Information Management
Patient Services
Legal & Compliance
Operations
Administration
Quality Assurance
Data Protection
Customer Service
Relevant Roles
Medical Records Officer
Health Information Manager
Healthcare Administrator
Compliance Officer
Medical Secretary
Patient Services Coordinator
Healthcare Facility Manager
Legal Compliance Manager
Data Protection Officer
Medical Records Clerk
Healthcare Operations Manager
Patient Relations Manager
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