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Patient Name: Date of Birth: Patient's Phone: Last 4 digit SSN (optional). Provider's Name: Recipient's Name: ☐ Methodist/Methodist Children's Hospital. How do I have someone else pick up my medical records for me? On your signed Patient Request for Access Form you can include in the “Send my records to” section D Methodist Hospital Southlake. D Methodist Hospital Northlake D Discharge Summary I need not sign this form in order to assure treatment.Methodist Health System Hospitals and Clinics are required under state and Release of Medical Information form before they may provide a copy of a This authorization covers materials considered “hospital records” reasonably capable of being reduced to printed form. Methodist Le Bonheur Healthcare and its Medical records are confidential. For a copy of your Houston Methodist records, send a signed release form to the facility that provided services. Follow the step-by-step guide to get your Free Hospital Discharge Papers Form Methodist edited with ease: Hit the Get Form button on this page. You will go to Fill Methodist Hospital Discharge Papers, Edit online. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller ✓ Instantly. Try Now! Patient Forms. WELCOME INFORMATION · NEW PATIENT FORM · PATIENT CONSENT FORM · PATIENT PREFERENCE REGARDING COMMUNICATION OF PHI · RELEASE OF PHI