Notification of Request for Medical Records from Provider


PDF Version:

TO:   All Medicaid Providers


RE:   Notification of Request for Medical Records from Provider



The Alabama Medicaid Agency (Medicaid) has created a new form titled “Notification of Request for Medical Records from Provider.” This form should be used by all Medicaid providers to notify Medicaid that a recipient has requested copies of their medical records.


It is the Medicaid provider’s responsibility to collect all information from the requestor regarding the purpose and nature of the information being requested and submit this information to Medicaid. Once the form is faxed, the provider should release the requested information to the recipient as Medicaid will no longer provide a response to the provider.


Providers are to ensure that all HIPAA Privacy and Security rules are met regarding an individual’s “right of access to inspect and obtain a copy of protected health information about the individual” (as stated in 45 C.F.R. §164.524).   


The “Notification of Request for Medicaid Records from Provider” form is available on this webpage:


If you should have any questions regarding this ALERT, please contact Zeffie Smith at (334) 242-5302 or Codie Rowland at (334) 242-5248.

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