Get Medical Records Release Form - Las Vegas Urology!

This guide provides clear and detailed instructions for filling out the Medical Records Release Form for Las Vegas Urology online. Whether you are a patient or assisting someone else, this step-by-step approach will help you complete the form accurately.

Follow the steps to fill out the Medical Records Release Form seamlessly.

1. Click the ‘Get Form’ button to access the Medical Records Release Form and open it in your online editor.
2. In the 'DATE' section, enter the current date to establish when the request is being made.
3. In the 'TO' field, specify the name of the person or entity to whom the medical records will be sent.
4. Enter the 'FAX#' where the records should be sent if applicable; otherwise, leave this field blank.
5. Fill in the 'Patient Name' section with the full name of the individual whose records are being requested.
6. Complete the 'Patient Address' section with the current address of the patient.
7. Provide the patient's 'DOB' (date of birth) to help identify the individual clearly.
8. Include the 'SS#' (Social Security number) of the patient for verification purposes.
9. Choose the types of records you wish to be released by checking the corresponding boxes, such as 'All Medical Records', 'Radiology Reports', 'Labs', or 'All Doctor Consultation Notes'.
10. Indicate the doctor’s name to whom the records are to be sent on the line provided.
11. Select the relevant address from the provided list where the records should be sent, ensuring the correct fax number is noted if necessary.
12. After all sections are completed, sign the form in the 'Patient Signature' field to authorize the release of records.
13. Enter the date of signing in the 'Date' section next to the patient signature.
14. If needed, a witness can sign the form in the 'Witness Signature' section, followed by entering the date.
15. Finally, once all sections are completed, you can save changes, download, print, or share the form as required.

Begin filling out your Medical Records Release Form online now to ensure a smooth process.