be_ixf;ym_202007 d_09; ct_50

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

1.800.506.6394 | 830.379.2411 | GRMC Staff Portal

Home
Clinical Services
Patient Support
Urgent Care
Wellness Center
Careers & Volunteering
About Us
Contact Us
GRMC Staff
COVID-19 Resources

Our Physicians
Visitor Information
Calendar
Driving Directions
Contact Us
Pay My Bill

   
Our Physicians
Visitor Information
Calendar
Driving Directions
Contact Us
Pay My Bill
Home
Clinical ServicesBirthing CenterLabor and Delivery
New Mom and Pregnancy Packet
Birthing Center Classes
Neonatology
Postpartum Care
Breast Feeding Support
Maternal Fetal Medicine
Newborn Portraits
Breastfeeding Supplies
FAQ
Diagnostic and Laboratory ServicesImaging and Radiology Procedures
Cardiovascular
3D Mammogram
Lab Services
Curbside Lab Draws
Infusion Therapy
Endoscopy
Sleep Studies
RehabilitationCardiac Rehab
Outpatient Rehab
Inpatient Rehab
CardiovascularCardiac Rehab Center
Cath Lab
Interventional Radiology
Cardiopulmonary
SurgeryWhat to Expect & How to Prepare
Robotic Surgery
Orthopedics
Behavioral HealthHeritage Program for Seniors
Teddy Buerger Center
One-Eighty
Emergency DepartmentS.A.N.E.
ER vs. Urgent Care vs. Free Standing ER
Urgent Care at Clear Springs
Telemedicine
Hospitalist Services
Guadalupe Clinic
Hospice
Palliative Care
Wound Care
Patient SupportAdmission & Registration
Classes & Support Groups
GRMC Patient Portal
Financial Information & Services
Visitor Information
Gift Shop
Hospital Transportation
Prescription Assistance Program (PAP)
Behavioral Health
Calendar
Patient Tools
Pastoral Care
Social Work & Case Management
Nutritional Services
News & Updates
Privacy & Health Information
Guadalupe Healthcare Network
Urgent Care
Wellness Center
Careers & VolunteeringI am a PhysicianMedical Staff Services
Learn about Seguin
Recruitment
Prospective Employee
I want to Volunteer
Request for Employee Health Records
About GRMCAdministration & Governing Board
Giving to GRMC
Our Physicians
Online Reviews
Testimonials
Accolades
GRMG
Accepted Health Insurance
News & Updates
Events
Videos
Share Your Experience

Request for 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:*

Date Format: 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.

Careers & Volunteering

I am a Physician

Medical Staff Services
Learn about Seguin
Recruitment

Prospective Employee

I want to volunteer

Request for Employee Health Records

If you have any questions about the Employee Health Records Form, please call (830) 401-7325.

Guadalupe Regional Medical Center | 1215 E. Court Street | Seguin, Texas 78155 | 1.800.506.6394 | 830.379.2411

Home
Careers & Volunteering
Vendors
GRMG
Contact Us

Facebook
Twitter
Instagram
LinkedIN

Privacy Policy
Terms of Use
Joint Notice of Privacy Practices

Request for Employee Health Records

Authorization

Employee Information*

Record Release*

Delivery of Records*