Request Status
Current stage of the medical record transfer.
Patient Record Request Details
Details for request ID RR016

Patient Name

Jeffrey Gonzalez

MRN

MRN93546

Status

Denied

Requesting From

Suburban Health

Requested Date

3/11/2023

Case Details
Additional information and context for this request.

This record request was initiated for continuity of care following the patient's recent relocation. The patient, Jeffrey Gonzalez, has a complex medical history including chronic hypertension and Type 2 Diabetes, managed by Suburban Health. We require the last 24 months of clinical notes, lab results, and imaging reports to ensure a safe and effective transition to our practice.

Please expedite this request as the patient has an upcoming appointment for medication management. The signed patient consent form is attached to the electronic request sent via the health information exchange (HIE).

Denial Reason

The request was denied due to an invalid or expired patient consent form. Please obtain a new consent form from the patient and resubmit the request.

Eligibility Results
Patient's coverage details based on last check.
StatusInactive
Plan NameUnitedHealthcare Choice Plus
Coverage Dates01/01/2023 - 12/31/2023
Primary Care Co-payN/A
Specialist Co-payN/A

Deductibles

IndividualN/A / N/A
FamilyN/A / N/A

Out-of-Pocket Max

IndividualN/A / N/A
FamilyN/A / N/A

Notes

Coverage terminated on 12/31/2023. Please check for new insurance.

J

Thanks for your help, I really appreciate it.

Mar 13, 4:58 PM
Y

The transfer is complete. The records are now available for your specialist.

Mar 16, 7:22 AM
J

Okay, I will follow up with my previous provider to see what's causing the delay.

Mar 17, 5:00 PM