Medical Records Sorting and Indexing Request Form
Use this form to request sorting and indexing support for a medical records batch. Provide the request details, sorting preferences, indexing needs, and delivery instructions.
Requestor and Organization Details
Requestor's Full Name
*
First Name
Last Name
Organization/Department Name
*
Role / Job Title
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Records Sorting and Indexing Request
Record Batch Name / Case Reference Label
*
Records Date Range Start
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Records Date Range End
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Sorting Method
*
By Date
By Patient Name
By Document Type
By Record Source
Custom Order
Indexing Categories Needed
*
Dates
Document Types
Departments
Providers
Patient Identifiers
Custom Categories
Special Instructions for Sorting/Indexing
Delivery and Handling Details
Delivery Method
*
Secure Digital Delivery
On-Site Pickup
Internal Transfer
Other
Desired Completion Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Handling Notes or Priority Instructions
Submit Request
Should be Empty: