Get Medical Records Release Form - The University Of Tennessee ... - Utmedicalcenter

Filling out the Medical Records Release Form is essential to ensure that your health information is properly shared and handled. This guide provides step-by-step instructions to help you navigate the form accurately and efficiently.

Follow the steps to complete the Medical Records Release Form.

1. Click the ‘Get Form’ button to access the Medical Records Release Form and open it for editing.
2. In the first section, enter the name of the entity that will be releasing your health information. This could be a healthcare provider or organization.
3. Next, fill in the patient's full name and date of birth accurately. This information is vital to identify the medical records that need to be released.
4. Provide the patient's address and telephone number to ensure they can be contacted if needed.
5. Input the social security number of the patient. This number helps to verify the patient's identity.
6. Indicate the period of healthcare by specifying the start and end dates for the medical information you want released.
7. Select the type of medical records you wish to release by checking the appropriate boxes. Options include Complete Medical Record(s), Pathology, Laboratory Tests, and more.
8. State the purpose for which the information will be used or disclosed, choosing from the options provided or specifying another reason if necessary.
9. List the name and address of the person or entity to whom the records will be sent.
10. Sign and date the authorization form at the bottom. Ensure that your printed name is also included, along with the authority of a personal representative if someone is signing on behalf of the patient.
11. Review the completed form for accuracy, then save changes, download a copy, or print it as needed.

Complete your Medical Records Release Form online today to ensure your health information is managed according to your needs.