Medical history request
Requirements for the request of the medical history
The history and clinical records are private documents and subject to confidentiality, which can only be known by the user, the health team and the people authorized by current regulations.
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The request for medical history by third parties can only be submitted with prior written authorization by the user or in cases provided by law.
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Clofán, seeking to streamline the processes of processing and delivery of clinical records requested by users, presents the requirements demanded at the time of requesting the clinical history:
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If you are the owner of the medical record, you must request it in person with your identity document at the Document Administration Center window, 11th floor.
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If you are the father or mother of a minor user:
• Original identification document of the father or mother requesting the medical history of the minor.
• Identity document of the minor (it can be a copy), identity card or civil registry.
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If you are authorized by the father or mother of the minor:
• Clinical history request letter format, in which you must specify the reasons for the medical history request signed by the father or mother of the minor.
• Identity document of the minor (it can be a copy), identity card or civil registry
• Original identification document of the person claiming the minor's medical history.
If you are a relative or a third party authorized by the user:
• Original identification document
• Copy of the user identification document
• Written authorization letter format specifying the reasons for requesting the medical history, signed by the user and by the authorized person.
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If you are a relative of a user of legal age in an unconscious or incapacitated state:
• Original identification document
• Copy of the user identification document
• Written authorization letter format specifying the reasons for requesting the medical history and your commitment to use the information only for the aforementioned, preserving its confidentiality and reserve.
• Document stating the state of disability or unconsciousness of the user.
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If you are a relative of a deceased user, you must attach:
Letter in which you must specify the reasons for requesting the medical history and minimum data such as ID number, full names and surnames of the applicant.
• Original death certificate or copy.
• Marriage certificate of the deceased if it is the spouse who makes the request; or if the deceased was not married, but lived with this person, you must bring an out-of-court statement indicating that they lived together.
• If the applicant is a brother or sister, you must attach the birth certificate of both the applicant and the deceased, to verify the relationship.
• If it is the child or one of the parents who makes the request, you must attach the birth certificate to prove the relationship.
• Photocopy of the identity card of the deceased.
• Photocopy of the Applicant's identity card.
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If you only require the result of one exam:
You must bear in mind that these documents are also part of the medical history, therefore, they are subject to confidentiality and custody upon delivery.
The results of the diagnostic aid exams are delivered at the Document Administration Center window, 11th floor, within 5 business days of the exam. If you are a third party, you must present your identity document, the copy of the identity document of the user who took the exam and sign the required documents at the time of delivery.
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About letters of authorization:
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Clofán allows you to download a letter of authorization as an example to follow, but you can manage the content to your preference, guaranteeing that all the minimum data is included, such as identification and names of the applicant, the holder of the medical record, reason for request, date of request and signature.
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Each time a medical history request is required, it must be with a current date.
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About the documents presented:
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The documents presented will be used specifically to validate the information of the request, these can be attached to the medical record for traceability of the process or returned to the requesting user.
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Cost of the copy of medical history:
The printing of the copy of the clinical history does not generate any cost. However, when it comes to long stories, sending it by email will be suggested.
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Hours of operation:
From Monday to Friday from 07:00 a.m. to 1:00 p.m. m. to 06:00 p.m. m. continuous day and Saturdays from 08:00 a.m. to 1:00 p.m. m. at 12:00 p.m.
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Contacts Phone:
604 444 00 90 ext. 1173
Email: cad@clofan.com