Get Medical Records Release Form - Riverview Health

Filling out the Medical Records Release Form is an essential step for patients wanting to authorize the sharing of their health information. This guide provides clear instructions on how to complete the form effectively and securely online.

Follow the steps to accurately complete the Medical Records Release Form online.

1. To begin the process, click the ‘Get Form’ button to access the Medical Records Release Form. This will allow you to open the form in your preferred document editor for completion.
2. In the first section, enter the patient’s full name and date of birth. This is important for correctly identifying the medical records you wish to release.
3. Fill out the patient's address, including city, state, and zip code. Also, provide the patient's telephone number and social security number for further identification.
4. Next, detail the information recipient’s details by entering the physician's name, telephone number, fax number, and address, ensuring all information is accurate for proper communication.
5. In the section specifying the scope of records to be released, check the appropriate boxes for the types of medical records you wish to authorize for release. This may include complete health records, lab reports, and more.
6. If there are specific dates for the records you wish to release, indicate them clearly in the provided fields.
7. Read the authorization comprehensively to understand your rights and the limitations regarding the sharing of your medical information.
8. Finally, sign and date the form in the designated areas. If you are signing on behalf of a minor or an individual who is unable to sign, include your signature as a legal representative.
9. After completing the form, you can save your changes, download the document, print it, or share it as needed.

Complete your Medical Records Release Form online today to ensure your health information is shared quickly and securely.