Request Status
Current stage of the medical record transfer.
Patient Record Request Details
Details for request ID RR018

Patient Name

Amy Hernandez

MRN

MRN19656

Status

Fulfilled

Requesting From

Suburban Health

Requested Date

5/17/2025

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, Amy Hernandez, 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).

Eligibility Results
Patient's coverage details based on last check.
StatusActive
Plan NameBlueCross PPO Gold
Coverage Dates01/01/2024 - 12/31/2024
Primary Care Co-pay$25
Specialist Co-pay$50

Deductibles

Individual$850.75 / $1,500
Family$1,250.00 / $3,000

Out-of-Pocket Max

Individual$2,100.50 / $5,000
Family$3,500.00 / $10,000

A

Just confirming my new address is on file for the transfer.

May 19, 6:35 PM
Y

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

May 21, 1:26 PM
A

Just confirming my new address is on file for the transfer.

May 23, 4:36 AM
Y

We've initiated the request with your previous provider and are awaiting their response.

May 25, 9:56 PM
A

Thank you for the update! When do you think it will be completed?

May 27, 3:29 AM