Get Medical Records Release Form - Primary Care Center

Filling out the Medical Records Release Form is an essential step in ensuring that your medical information is shared appropriately. This guide provides a clear, step-by-step approach to assist you in completing the form online with confidence.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Medical Records Release Form and open it in your preferred editor.
2. In the first section, enter the date in the designated space provided. This helps to document when the form was filled out.
3. Complete the 'Patient Name' field with your full name as it appears in your medical records. Make sure to provide accurate details to avoid any processing issues.
4. Specify the dates for the records you wish to release. You can choose to enter specific start and end dates in the 'Please Release Records (dates)' section or select 'ALL' if you want all records.
5. Indicate the recipient of the records in the 'Forward to' section. This could be your new doctor, hospital, or yourself. Fill in their name clearly.
6. Provide the recipient's address, ensuring it is complete for proper delivery of your records.
7. Enter a contact number for the recipient if applicable. This allows for any necessary communication regarding the record transfer.
8. Select the reason for leaving your current primary care provider by checking the appropriate box in the 'Reason for Leaving' section. If you select 'Other,' include a brief explanation.
9. Be aware of the $25 processing fee that is to be paid for record release. Ensure you have this payment ready.
10. After completing the form, sign and date the form in the designated signature area to validate your request.
11. Finally, review all information for accuracy. Save your changes, and choose to download, print, or share the completed form as needed.

Start filling out your Medical Records Release Form online today to ensure your medical information is shared without delays.