Get Kids Plus Pediatrics

Filling out the Kids Plus Pediatrics medical records release form is a straightforward process that allows you to authorize the transfer of medical records efficiently. This guide provides clear and detailed steps to assist you in completing the form correctly.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the patient's last name, first name, and middle initial in the corresponding fields.
3. Provide the patient's street address, city, state, and zip code in the designated sections.
4. Fill in the date of birth for the patient to confirm their identity.
5. Specify the name of the person or organization to which the medical records will be sent.
6. Complete the address fields for the recipient, including city, state, and zip code.
7. Indicate the reason for the transfer by checking the appropriate box, such as 'insurance change' or 'transfer of care'.
8. Choose whether to request all records or specify particular dates of service.
9. If there is any specific information that should not be released, please note it in the specified area.
10. Sign the authorization to allow Kids Plus Pediatrics to release the information, and date it accordingly.
11. Keep in mind that the completed form must be submitted for the release process to begin. Records will be mailed within 30 days unless they are off-site, in which case it may take 60 days.
12. You can save your changes, download, print, or share the filled form as needed.

Complete your documents online today for a smooth and secure processing experience.