In our increasingly digitized world, the privacy and accessibility of health records have taken center stage, bridging the gap between patient rights and healthcare administration. The ORC 110 B form, a crucial document within this landscape, serves as a tool for patients seeking access to their designated record set from Providence Healthcare facilities. This form allows individuals to request their health records in various formats, such as paper, disc, or secure email, covering a range of services from history and physical, operative reports, diagnostic reports including lab and X-ray, discharge summaries, emergency department reports, office visits, outpatient progress notes, to billing statements and CDs of diagnostic films. Specifically designed for residents in states such as Alaska, California, Montana, Oregon, and Washington, it encompasses requests for records spanning specified date ranges. Importantly, while the form facilitates access to essential health documentation free of charge for specific records, it also outlines the circumstances under which fees may be applicable, underscoring the balance between service accessibility and the operational needs of healthcare providers. Additionally, the form includes provisions for personal representatives to act on behalf of patients, reflecting a comprehensive approach to healthcare information management. The procedure for submitting the form is streamlined, with clear instructions for both patients and their representatives, including details on where and how to send the form, especially for those treated at multiple facilities or unsure about the appropriate contact information for Providence Health and Services.
| Question | Answer |
|---|---|
| Form Name | Form Orc 110 B |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | medical records request providence request record set form |