Get Female Release Of Medical Records Consent Form - Sottopelle

Filling out the Female Release Of Medical Records Consent Form - SottoPelle is an essential process for ensuring your healthcare provider has the necessary medical documentation prior to your appointment. This guide will walk you through each section of the form, making the process straightforward and accessible.

Follow the steps to complete the form online with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Enter the date at the top of the form where indicated. This helps to establish when the request for records is being made.
3. Fill in your physician's name, address, city, state, and phone number in the appropriate fields. This ensures that the records are directed to the correct provider.
4. In the section labeled 'I, _________,' fill in your full name. This authorizes your physician to disclose your medical information.
5. Specify your doctor’s name in the designated field, clarifying which specific provider you are allowing to release your medical records.
6. Select the types of medical records you are authorizing to be disclosed by checking the appropriate boxes. Options include mammogram report, pap report, bone density, ultrasounds, endometrial biopsy, and current hormone labs.
7. If there are any restrictions on the protected health information (PHI) to be disclosed, indicate 'Yes' or 'No.' If 'Yes,' provide an explanation in the space provided.
8. Note that the form specifically mentions that medical records on CDs, DVDs, and films are not accepted. Ensure only paper copies are sent.
9. Complete the section for sending the records, filling in 'Gino Tutera, M.D. PC and Providers,' along with the address and contact information provided.
10. Finally, print your name, date of birth, and sign the form. Don't forget to include the date on which you are signing the form.
11. Once all fields are completed and verified for accuracy, save the form, download, print, or share it as necessary.

Take the necessary steps to ensure your medical information is accurately shared by completing your forms online today.