Get Authorization To Obtain Medical Records. Best's Online Rating Report

This guide provides clear, step-by-step instructions on how to properly fill out the Authorization To Obtain Medical Records. Best's Online Rating Report form. This is intended for users with varying levels of experience in handling medical records requests, ensuring a smooth and efficient process.

Follow the steps to complete the Authorization To Obtain Medical Records form effectively.

1. Press the ‘Get Form’ button to access the Authorization To Obtain Medical Records form and open it in your preferred online document editor.
2. Begin by filling out the claimant information section. This includes entering your first name, middle initial, last name, address, city, state, zip code, phone number, email, social security number or employer identification number, date of birth, and your relationship to the person whose records are being requested.
3. Next, identify the decedent or the person whose medical records are being requested. Complete the fields labeled ‘FIRST’, ‘MI’, ‘LAST’, and specify the contract number and date of death.
4. Proceed to the payment options section. Indicate your preferred method of payment, providing details as requested. If you select the BenefitNOW Account option, ensure you understand the requirements associated with it.
5. In the income tax withholdings section, select whether to withhold federal and state income taxes based on your preferences and provide the necessary certification information.
6. Attach any required documentation as indicated in section D. Be sure to include a certified death certificate, the original contract, estate documents, or any other relevant documentation.
7. Finally, in the claimant statement and signature section, review all information for accuracy. Sign and date the form to certify its correctness. Remember to return the form along with the attached documents in the provided envelope.
8. After completing the form, you can save changes, download a copy for your records, and print it for submission.

Submit your documents online today to efficiently request your medical records.