{"id":180,"date":"2023-05-15T02:31:12","date_gmt":"2023-05-15T02:31:12","guid":{"rendered":"https:\/\/dbhds.virginia.gov\/facilities\/swvmhi\/?page_id=180"},"modified":"2023-06-30T15:42:06","modified_gmt":"2023-06-30T15:42:06","slug":"ancestor-request-forms","status":"publish","type":"page","link":"https:\/\/dbhds.virginia.gov\/facilities\/swvmhi\/contact-us\/ancestor-request-forms\/","title":{"rendered":"Ancestor Request Forms"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Submitting a Request<\/h2>\n\n\n\n<p>To request a deceased patient&#8217;s record, please fill the following form out:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Authorize for Release of Information on Deceased&nbsp;(PDF)<\/li>\n<\/ul>\n\n\n\n<p>Please send the completed form to the following address or fax number:<\/p>\n\n\n\n<p>SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE<br>Attn: Health Information Management Department<br>340 Bagley Circle<\/p>\n\n\n\n<p>Marion, Virginia 24354<\/p>\n\n\n\n<p>Fax Number:<\/p>\n\n\n\n<p>888-865-6681<\/p>\n\n\n\n<p><em><a href=\"http:\/\/get.adobe.com\/reader\/\"><\/a><a href=\"http:\/\/get.adobe.com\/reader\/\">Adobe Reader<\/a>&nbsp;is required to view this form.<\/em><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Submitting a Request To request a deceased patient&#8217;s record, please fill the following form out: Please send the completed form to the following address or fax number: SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTEAttn: Health Information Management Department340 Bagley Circle Marion, Virginia 24354 Fax Number: 888-865-6681 Adobe Reader&nbsp;is required to view this&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":170,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/full-width-page.php","meta":{"footnotes":""},"class_list":["post-180","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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