be_ixf;ym_202107 d_24; ct_50

be_ixf; php_sdk; php_sdk_1.4.23
https://www.grmedcenter.com/about/request-for-employee-health-records/
https://www.grmedcenter.com/about/request-for-employee-health-records/

Call us: | 830.379.2411

Our Physicians
Careers
News & Updates
Driving Directions
Contact Us
Pay My Bill

Medical Services
Patient & Visitors
Urgent Care
Wellness Center
Health Library
About GRMC

Our Physicians
Careers
News & Updates
Driving Directions
Contact Us
Pay My Bill

Medical Services
Patient & Visitors
Urgent Care
Wellness Center
Health Library
About GRMC

Home » About GRMC » Employee Health Records

Employee Health Records

Authorization
I hereby authorize Guadalupe Regional Medical Center to release records of:*
- Employee
- Volunteer
- Student
- Physician
- Other
Employee Information*
First Name
Last Name
Phone
Email
Last 4 of SSN*
Date of Birth:*

MM slash DD slash YYYY
Record Release*
Release Employee Health Record to: (name of self/person/physician/company):*
The records requested are (TB test, immunization record, etc.):*
The records are requested for the following purposes: (personal, school, etc.):*
Delivery of Records*
How would you prefer Employee Health to provide records?*
- Pick of copy in Employee Health/Employee Services
- Email
- Fax
- Mail
Telephone number to call when records are ready*
Fax Number*
Email*
Name*

First

Last
Address*

Street Address

Address Line 2

City

State

ZIP Code
Permission to Release Information*
- By checking this box, I agree all information stated above is correct and I give permission to GRMC to release my Employee Health Information to the recipients stated above.
If you have any questions about the Employee Health Records Form, please call (830) 401-7325. Employee Health will provide this information within 3 – 10 days.

About GRMC

Careers & Volunteering
Employee Health Records
Administration & Governing Board
Awards
Guadalupe Regional Medical Group
Guadalupe Regional Medical Foundation
Events
Online Reviews
Videos
Testimonials
Share Your Experience
Our Physicians
News & Updates

CALL 830.401.7325 FOR MORE INFORMATION

All About GRMC Services

Careers & Volunteering
Employee Health Records
Administration & Governing Board
Awards
Guadalupe Regional Medical Group
Guadalupe Regional Medical Foundation
Events
Online Reviews
Videos
Testimonials
Share Your Experience
Our Physicians
News & Updates

    
Call us: 830.379.2411
1.800.506.6394
1215 E. Court Street 
Seguin, Texas 78155
 GRMC Staff Portal
Careers & Volunteering
Vendors
Guadalupe Healthcare Network
Privacy Policy
Terms of use
Joint Notice of Privacy Practices
Privacy & Health Information
 
 Facebook
Twitter
Instagram
LinkedIN
YouTube
   

© 2021 Guadalupe Regional Medical Center. All Rights Reserved.