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Request to Obtain a Copy of Clinical Record Form

Patients or beneficiaries can request a copy of their medical records from a healthcare organization. Hospitals and clinics can use this request form to gather document requests from people who receive medical care and request a copy of their medical records.

Request to Obtain a Copy of Clinical Record Form


What is a request the obtain a copy of the clinical record?

The Request for a copy of clinical records form can be used by health care providers and organizations to fulfill patients' requests for copies of medical records. This request form includes the patient's name, date of birth, the purpose of the request, and signature field.

You can easily edit and design the form fields, design, and many other sections with For example, you can add a logo representing your healthcare institution to give a professional look to your form.

A request form is a document that is used to accept requests from your customers, employees, students, or from anyone depending on where you are working. Through a request form, you can accept time off requests, quote requests, donation requests, and many more types of requests. By doing all these online, you can both have an overview of the requests received and collect data from the respondents about their requests. 

A good request form should be collecting all the necessary information regarding the request to be made. For example, if it’s a leave request form, you should ask for all the necessary information such as requested leave dates, employee information, and anything else that could be beneficial to evaluate the request and proceed if it’s possible.

There are many benefits of having your request forms online. Some of them are: 

  • Saving papers and protecting the nature.
  • Having all form submissions in one place. 
  • Managing the requests easily. 
  • Getting notified by an email everytime a new request received. 
  • Integrating with third-party applications. 
  • Giving an easy access to your form through a link.

On’s templates library, there are many free request form templates using which you can get started quickly and customize your request form template however you like. From leave request form template to maintenance request form template and many others, you can choose a one that matches your needs and get started right away!