Get Ocmg Records Release Draft - Optumcare.com

Completing the OCMG Records Release DRAFT is an essential step in authorizing the release of your medical information. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Click 'Get Form' button to obtain the form and open it in your editor.
2. Begin by filling in your personal details. Enter your last name, first name, birthdate, and address, including city, state, and ZIP code. If applicable, provide your previous last name or alias used for prior treatments and contact numbers.
3. Specify the health care provider from whom you are requesting the release of your health records. Include their name, address, and contact information in the designated fields.
4. Next, identify the recipient of your health information by completing their detailed contact information as well.
5. Indicate the specific healthcare information you wish to authorize for release. You can select 'All healthcare information' or specify details related to particular treatments, conditions, or dates.
6. If applicable, provide authorization for the release of sensitive information, such as STD results or mental health records, by checking 'Yes' or 'No' in the provided sections.
7. If you have additional accounts or records you wish to transfer, please specify, and indicate any dates related to injuries, if relevant.
8. Review the fee schedule presented for copy services to understand any potential charges associated with your request.
9. Sign and date the authorization, ensuring you understand your rights regarding refusals and revocations. If you are signing on behalf of another individual, please attach appropriate documentation.
10. Once all sections are complete, save your changes. You may then choose to download, print, or share the completed form as needed.

Take action now by completing your OCMG Records Release DRAFT online.