Get Authorization To Release Mammography Films - Fox Chase Cancer ... - Fccc

This guide provides clear and supportive instructions for filling out the Authorization To Release Mammography Films form for Fox Chase Cancer Center online. Follow the steps carefully to ensure your request is processed efficiently.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the Authorization To Release Mammography Films form and open it in the editor.
2. Enter the name of the medical facility from which you are requesting the mammography films in the designated space.
3. Provide the fax number of the medical facility to facilitate communication specifically for your request.
4. Fill in the street address, city, state, and zip code of the medical facility to ensure accurate delivery.
5. Sign and print your name in the specified fields to authorize the release of your mammography films.
6. Enter your Social Security number, date of birth, and current address in the relevant sections to verify your identity.
7. Indicate the date you are filling out the form in the 'Today's Date' section.
8. Provide contact information, including your phone number and the name of the person who faxed the form, if applicable.
9. Review the completed form for accuracy and ensure all necessary fields are filled out properly.
10. Once you are satisfied with the form, save your changes, and choose to download, print, or share the form as needed.

Complete your documents online today for a smooth and efficient process.