Request for inspection, extract and copies of medical records and completion of insurance claims
Dear Patients,
If you need to inspect your medical records (hereafter referred to as MH), obtain an extract or copy, or file an insurance claim, please pay attention to the text below.
How to proceed?
You can request to inspect the medical records, obtain an extract or copy or file an insurance claim using the form available from the relevant hospital department, the Quality of Care Department of the hospital headquarters or the hospital website.
Request for a copy of a statement and access to medical records
How can you make a request?
- In person at the quality department officers - tel. +420 311 559 057, +420 311 559 058
- By e-mail zadostizd@nemocnice-horovice.cz
Who can apply and what is required for the application?
- Patient - ID card
- Legal guardian of a minor - ID card of the legal guardian and birth certificate of the minor
- Guardian - guardian's ID card and court order
- Person appointed by power of attorney with a well-defined scope* - power of attorney, ID card of the attorney
- For a deceased, close person** - death certificate, birth certificate and ID card of the close person
What will follow?
1. Inspection of the RO
- A member of our hospital staff will make an appointment with you to view your medical records. You can only look at your medical records under the supervision of our staff. Copies can be made by your own means
2. A copy or extract of the medical record
- A copy or extract of the QA will be made available to you by a member of the Quality Department within 30 days of receipt of your request. The copy or extract may be collected in person or sent by registered mail. They can also be sent by email after verification of the applicant's identity.
3. Completion of the insurance claim
- A Quality Officer will arrange to complete the insurance claim within 30 days of receipt of your application. The completed form can be picked up in person or can be sent by registered mail.
Payment for accessing medical records, obtaining an extract and copy, and filing a claim
Price list for administrative tasks
Shipping costs: according to the current price list of the Czech Post, s.p. for registered mail.
* power of attorney expires upon the death of the patient, unless the wording indicates otherwise
**parents, grandparents, children, grandchildren, sibling, spouse and registered partner
