Get Consent For Release Of Medical Information Patient ...

Filling out the consent for release of medical information is a crucial step in ensuring your medical records are shared securely and appropriately between healthcare providers. This guide will provide clear, step-by-step instructions to assist you in completing the form online.

Follow the steps to successfully complete your medical information release form.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Start by entering your full name in the 'Patient name' field. This identifies you as the individual authorizing the release.
3. Provide your date of birth in the designated field. This helps to confirm your identity, particularly in cases where there may be multiple patients with similar names.
4. Fill in your current address in the 'Address' section. Accurate contact information is essential for the healthcare provider to reach you if necessary.
5. Enter your phone number in the appropriate field. This ensures that the provider can contact you regarding any questions or clarifications about the form.
6. Specify the treatment dates for which you authorize the release of records by filling in the 'Treatment dates from' and 'to' fields.
7. In the 'I authorize' section, input your current physician's information, including their name and contact details.
8. Next, indicate to whom you are authorizing the release of your medical records by filling in your new physician's information.
9. Select the portions of your medical record you wish to release by checking the corresponding boxes, such as mental health records, HIV/AIDS, or substance abuse records.
10. Read and understand the stipulated statement regarding the duration and revocation of the authorization, then sign and date the form in the designated areas. If applicable, provide your relationship to the patient.
11. Lastly, include a witness signature, if required, to validate the consent.
12. Once you have completed the form, you can save your changes, download, print, or share the form as necessary.

Complete your consent for release of medical information online today to ensure your medical records are shared seamlessly.