Request Status
Current stage of the medical record transfer.
Patient Record Request Details
Details for request ID RR042

Patient Name

Chris Hernandez

MRN

MRN82986

Status

Fulfilled

Requesting From

General Hospital

Requested Date

3/13/2023

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, Chris Hernandez, has a complex medical history including chronic hypertension and Type 2 Diabetes, managed by General Hospital. 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

C

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

Mar 14, 10:29 PM
Y

Thank you for following up. Please let us know if they provide any new information.

Mar 15, 11:46 PM
C

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

Mar 16, 2:45 AM