Get Medical Records Release Form - Affinity Whole Health

Filling out the medical records release form is a vital step in obtaining your health information. This guide provides clear and detailed instructions to assist you in completing the Affinity Whole Health medical records release form online, ensuring a smooth process.

Follow the steps to complete the medical records release form.

1. Click the ‘Get Form’ button to access the form, allowing you to view and fill it out in your preferred editing format.
2. Begin by filling out the section titled 'Release my protected health information to'. Here, you should enter the name of the individual or organization you wish to share your medical records with.
3. Next, provide the fax number of the recipient in the designated area. This is important for allowing the efficient transfer of your medical information.
4. Enter the phone number of the recipient, ensuring that you include any necessary country or area codes.
5. Fill in the email address of the recipient if you prefer the records to be sent electronically.
6. If you would like the physical records mailed, complete the address section with the street address, city, state, and zip code.
7. In the 'Reason for release' section, briefly state the purpose for which you are requesting your medical records.
8. If there are any restrictions on the information being shared, please indicate them in the 'Restrictions' section.
9. You must authorize the release of your medical information by signing your name in the designated area. This step confirms your consent for Affinity Whole Health to release your records.
10. Print your name and date the form where indicated. Make sure that the date reflects the day when you are submitting the authorization.
11. Once you have completed all sections of the form, you can save your changes, download a copy, print it for submission, or share it as needed.

Complete your documents online today for a seamless experience.