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  • Emory Healthcare Authorization For The Release Of Protected Health Information

Get Emory Healthcare Authorization For The Release Of Protected Health Information

Medical Record Number for internal purposes Authorization for the Release of Protected Health Information Health Information Management Department Patient Name Last 4 digits of SSN Previous Name if applicable Address City State Zip Code Date of Birth Home Phone Work Phone Email address Emory Healthcare Facility/Facilities I authorize representatives from the following facility/facilities to disclose the health information as directed below Check .

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Graduated or former students will need to complete a Medical Records Release Form. After completing the form, then either mail, fax, or email/attach your request: The mailing address is: Emory University Student Health Services, ATTN: Medical Records, 1525 Clifton Rd, Atlanta, GA 30322. The eFax number is: 404-727-7343.

If you encounter any issues with your electronic request, please call our Release of Information Call Center at 404-712-4111.

The health system actually has three portals: Blue is the central one, Gold is used for patients of non-faculty clinicians, and Purple for the Emory Eye Center.

Our patient portals are a convenient way to securely view your personal health information and interact with Emory Healthcare. They play a key role in your health care – providing a 24/7 connection to the information you need to make better decisions.

Your MyChart patient portal is easy to use, enabling you to pay your bills and view statements, check in online before your appointment and schedule select appointments online.

Emory Healthcare will migrate from Cerner's electronic medical record to Epic's integrated and comprehensive health care software, effective Oct. 1, 2022.

To complete the transaction, the verifier will also need the employee's name, social security number and the Emory University employer code (11332).

For the Emory GOLD Patient Portal, contact your provider's office, call the Patient Portal line at 404-727-8820. Calls are answered 7:30 a.m.–5 p.m., Monday–Friday. Once you receive an email invitation, access the link in the message and follow the steps to activate your account.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232