You must agree to the following conditions to request the Medical Records.
The below form is applicable to INPATIENT admission only. Click on one of
the three topics below for more information. If you require assistance,
please contact the Medical Records Department at +961 1 372888 ext.
1062-1063-1064.
Introduction
To receive copies of a patient’s medical record, the patient must first
sign
a release of information letter to the hospital, and also attach a copy
of
the patient's passport as proof of identity.
You have the right to request of your dependents (e.g. children) if they
have not yet reached the age of 18. You can do this by providing the
hospital with a copy of the guardian's passport as well as the
authorization
letter, and submitting it with a copy of the child's birth certificate.
Medical Records Information
- Medical certificate (please specify visit and purpose)
- Other medical forms (please specify visit and doctor name)
- Copy of medical record (please specify visit and purpose)
Authorized Documents Needed
- In the case where you are requesting the medical record by yourself,
on the day you pick up the records, we must be given a copy of your
ID/passport. If you are requesting us to send via post, fax of
email, you will need to provide us with a copy of your ID/passport,
as well as the fax number or email address where the records should
be sent.
- In the case where a patient agrees to release the medical record to
an agent/representative, this agent/representative must provide us a
copy of the patient's ID/passport and authorization letter. The
letter must state that you are an authorized representative, state
that Clemenceau Medical Center should release these medical records
to this authorized representative, and have the patient’s signature,
along with the date the document was signed.