Get Medical Records Release Form - Hoag Medical Group

Filling out the Medical Records Release Form is essential for authorizing the sharing of your health information. This guide will provide clear and detailed instructions on how to navigate the form effectively online.

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

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out your name and date of birth in the designated spaces at the top of the form. Ensure that this information is accurate, as it will be used to identify your medical records.
3. In the section titled 'Requesting records from?', provide the name and facility from which you are requesting your records. Include attention, address, city, state, and zip code.
4. Next, specify where the records should be sent by filling in the information for Hoag Medical Group. The form already includes this information but double-check to confirm accuracy.
5. Specify the date range for the records you are requesting. Note that if no dates are entered, only the last two years of records will be released.
6. Indicate the types of records you wish to receive by checking the appropriate boxes. Options include labs, history and physical, progress notes, and additional information if necessary.
7. If applicable, authorize the release of statutorily protected information, such as mental health treatment information or HIV test results, by checking and initialing the corresponding boxes.
8. State the purpose of requesting these records by checking the appropriate box. If none are checked, the request will default to 'Continuing Care.'
9. Enter the expiration date for this authorization. If left blank, it will automatically expire six months from the date of signature.
10. Review your rights as outlined on the form carefully, and ensure you understand what is required. After reviewing, sign the form in the designated area.
11. If you are a legal representative, complete the relevant sections and attach proof of legal representation.
12. Finally, save the changes you made to the form, and choose to download, print, or share it as needed.

Complete your Medical Records Release Form online today to ensure a smooth process for accessing your health information.