Get Record Release Form ( Pdf ) - Oak Orchard Community Health Center - Oakorchardhealth

Filling out the Record Release Form is an important step in managing your health information. This guide will provide a clear and supportive walkthrough of the necessary steps to accurately complete the form online.

Follow the steps to effectively complete the Record Release Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out your name and the address of the doctor or facility that you are authorizing to release or obtain your health records. Ensure all details are accurate.
3. Select the appropriate option by checking one of the boxes for sending, obtaining, or picking up records, or sharing information verbally.
4. If you are transferring care, indicate this by checking the relevant box and provide details if necessary. If not transferring, simply check the other option.
5. Specify the purpose of the request by filling in the blank provided. This is necessary for processing the release effectively.
6. Select whether you would like all records or specify the information you wish to receive clearly in the designated area.
7. List the names and other required details of all patients covered by this authorization, ensuring to gather necessary information such as date of birth and relationship to the signer.
8. Determine the validity period for your authorization. Specify the expiration conditions or dates if applicable.
9. Read the terms carefully to understand your rights regarding the authorization, including how to cancel it if needed.
10. Finally, sign and date the form in the provided fields. Ensure your address information is also entered clearly.
11. After completing the form, make sure to save your changes. You can then download, print, or share your completed form as required.

Complete your Record Release Form online today to manage your health records effectively.