Get Medical Records Release Authorization - Obgyn Of Lancaster

Filling out the Medical Records Release Authorization form is an essential step for users wishing to request their medical records from the OBGYN of Lancaster. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to smoothly complete your authorization form

1. Press the 'Get Form' button to access the Medical Records Release Authorization - OBGYN Of Lancaster form and open it in your preferred online document editor.
2. Begin by entering your personal information in the spaces provided. This includes your complete name, date of birth, address, phone number, and fax number.
3. In the section labeled 'Access Request to Copy/Inspect,' indicate the organization that is permitted to disclose your health information, which in this case is the OBGYN of Lancaster, and provide the facility's address.
4. Next, specify the types of health information you wish to be disclosed. Include dates of service and select from the options such as complete medical records, progress notes, and any other specific items that may be relevant.
5. Read the section on the nature of the potentially sensitive information that may be included in your health records. Ensure that you understand this information is protected and may include details about confidential medical conditions.
6. Provide the name and address of the individual or organization to whom you are authorizing the disclosure of your medical records. Clearly state the purpose for this request, such as further medical care or personal reasons.
7. Review your rights regarding the inspection and obtaining copies of your protected health information. Take note of the conditions under which you can refuse to sign the authorization without affecting your treatment.
8. Acknowledge that this authorization may be subject to re-disclosure and that you can revoke this authorization in writing. Make sure to understand the expiration of this authorization.
9. Finally, sign and date the authorization at the bottom of the form. If someone else is signing on your behalf, include their signature and indicate your relationship to the patient.
10. Once you have completed the form, you may choose to save your changes, download it, print a copy for your records, or share the completed document with the relevant parties.

Take the next step in managing your health by completing your Medical Records Release Authorization form online today.