Get Medical Records Release Form. - Pdec.org - Pdec

Filling out the Medical Records Release Form is an essential step in ensuring your medical information is shared securely and efficiently. This guide provides clear, step-by-step instructions to help you complete the form accurately and easily.

Follow the steps to successfully complete the Medical Records Release Form.

1. Click the ‘Get Form’ button to obtain the Medical Records Release Form. This will allow you to access the form in an online format.
2. Complete the patient information section. Enter your name, birthdate, phone number, and address, including city, state, and zip code. Ensure that all details are accurate for a smooth processing.
3. In the facility/person(s) to receive records section, provide the name, address, phone number, and fax number of the individual or facility you wish to receive your medical records.
4. Next, fill out the facility/person(s) to release records section with the name, address, phone number, and fax number of the provider or entity releasing your records.
5. Initial in the spaces provided to authorize the release of specific types of medical information. You must place your initials next to each type of information you consent to disclose, such as progress notes, lab reports, and more.
6. Be aware that forms submitted without initials in the appropriate spaces will be returned. It's crucial to ensure this section is complete to avoid delays.
7. Understand that you may revoke this authorization in writing at any time. However, please note that revoking authorization does not impact any actions taken prior.
8. Finally, sign and date the form at the bottom to validate your authorization for the release of your medical records.
9. Once completed, save changes to the form. You may choose to download, print, or share the document as required.

Start filling out your Medical Records Release Form online today!