Get Transcript Authorization Form.docx

Filling out the Transcript Authorization Form online is a straightforward process that ensures your request for medical records is processed efficiently. This guide provides step-by-step instructions to help you complete the form accurately and easily.

Follow the steps to complete the Transcript Authorization Form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred digital editor.
2. Enter your full name in the 'Patient Name' field, ensuring it matches the name on your medical records.
3. Fill in your complete address in the 'Address' field, including city, state, and ZIP code.
4. Provide your telephone number in the 'Telephone' field to ensure you can be contacted if necessary.
5. Review the authorization statement, confirming you request that your medical records be released according to the attached OCA Official Form No: 960.
6. Sign and date the form in the designated area to validate your request, or have your guardian sign if applicable.
7. If applicable, indicate the 'Number of pages' and total amount due for copying if records are to be sent to a non-health care provider.
8. Complete the 'Postage' and 'Total Amount Due' sections if you anticipate fees, then enter the date payment was received.
9. Ensure all fields are accurately filled out, review your information, and save your changes.
10. Download, print, or share the completed form as needed for submission.

Complete your Transcript Authorization Form online now for a seamless record request process.