• Deceased Parent Medical Record Request Form

    Deceased Parent Medical Record Request Form
  • We maintain and protect the individual's health and personal information, in consonance to the Health Insurance Portability and Accountability Act (HIPAA). As provided for under the said Act:

    45 CFR 164.502 (g)(4) Implementation specification: Deceased individuals. If under applicable law an executor, administrator, or other person has authority to act on behalf of a deceased individual or of the individual’s estate, a covered entity must treat such person as a personal representative under this subchapter, with respect to protected health information relevant to such personal representation.

    As required for under 45 CFR 164.514 (h) of HIPAA, the law requires a set of standard verification requirements in order to validate the person's identity requesting for a Protected Health Information. In the case of a deceased, the person requesting must provide proof of documentation showing the capacity to obtain said Protected Health Information, such as proving kinship as a parent, relative, or as surviving spouse of the deceased.

    Following the provisions of the law above, the representative requesting must provide the following:

    • A completed Deceased Parent Medical Record Request Form;
    • Documentary proof of filiation with the Deceased; and
    • An attached copy of your photo ID
  • Date of Birth
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  • Date of Death
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  • Records Requested

  • Please attach your document(s) on the file upload field below. The following are examples of documentary proof of filiation:

    • Copy of Birth Certificate or Death Certificate identifying the next of kin;
    • A court declaration estabilishing authority on behalf of the deceased, such as grant of probate, among others;
    • Proof of a valid marriage indicating effectivity at the time of death;
    • Any other legal doument establishing kinship to the deceased.
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