Request Status
Current stage of the medical record transfer.
Patient Record Request Details
Details for request ID RR019

Patient Name

Daniel Baker

MRN

MRN55762

Status

Denied

Requesting From

Suburban Health

Requested Date

9/13/2025

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, Daniel Baker, 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.

D

Can you confirm you received the documents I sent over last week?

Sep 17, 1:40 PM
Y

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

Sep 20, 6:16 AM
D

I've uploaded the consent form you requested. Please let me know if you need anything else.

Sep 21, 6:12 AM