The Patient Record Request Tool is to assist you in generating a Record Request form to be printed, signed/dated and sent to Myriad Medical Records by email, fax or mail. Not all fields are required; however, if there is not enough information to locate and verify the person named as patient, or not enough information to fulfill the request, there will be delays.
If you're requesting your own records, you understand
- Crescendo Biosciences, Inc. (“Myriad”) is a subsidiary of Myriad Genetics, Inc.
- If Myriad is unable to confirm my identity based on the information provided in this form and the Company's records, then, in the interest of patient privacy, Myriad will contact me to further confirm my identity before releasing records.
- Every effort will be made to fulfill my request as soon as possible, but it may take up to 30 days for Myriad to process my request.
- If I am requesting a copy of my test report, Myriad is required by certain regulations to wait 8 calendar days after the test has reported before they can send a copy to me directly.
- If I am requesting records as the patient's authorized representative, I must include a copy of the appropriate legal documentation verifying my authority as the patient's personal representative (e.g., court appointed guardian, durable power of attorney for health care, advanced directive, living will, etc.).
- If someone other than the patient will be signing the generated form, a copy of documentation appointing this person as the legal representative is required, these documents should be sent in with the completed form:
- For an Incapacitated Adult: A copy of court appointed guardian, durable power of attorney for health care.
- For a Deceased Patient: A copy of the death certificate is required. If the Record Request form is being signed by the patient’s surviving spouse then no additional documents are required. Requests by other individuals a copy of the death certificate and secondary paperwork is required, (i.e., will or estate designation documentation).
When filling out the fields, additional instructions for each field will be in italics, anything in Red is required. As you fill the information additional fields may appear if additional information is needed.
If you have any questions or problems please call Customer Service at 1-877-743-8639.