Get 314 4546060 Form

Filling out the 314 4546060 Form online is an essential step in authorizing the release of your medical information from St. Louis Children’s Hospital. This guide will provide you with clear and supportive instructions to help you navigate each section of the form effortlessly.

Follow the steps to complete the form correctly.

1. Click the ‘Get Form’ button to access the 314 4546060 Form and open it in the appropriate online editor.
2. In the first section, enter the former name(s) of the individual, if applicable. This helps the hospital locate the correct records. Then, provide the date of birth.
3. Next, input the individual's social security number in the designated field. This is important for accurate identification.
4. In the information release section, select the appropriate boxes for the specific documents you want to be released, such as the discharge summary or laboratory results. Specify any additional items in the 'Other' field if needed.
5. Fill in the dates of treatment to ensure that you request the relevant medical records.
6. Indicate where to send the released information. Provide the name of the recipient, their street address, city, state, zip code, and telephone number.
7. In the purpose section, briefly describe why you are requesting the medical information, which is important for proper processing.
8. Review the authorization section carefully, and sign the form where prompted. Also, include the date you are signing.
9. If signing on behalf of another person, include your relationship to them and attach any required documentation, such as proof of guardianship.
10. Finally, save any changes you have made to the form. You can then download, print, or share the completed document as needed.

Complete your documents online today and ensure a smooth release of your medical information.