Get Authorization Records Release (or Revoke) Form To A Family Member (white).doc

Filling out the Authorization Records Release (or Revoke) Form To A Family Member is an essential step in managing your medical records. This guide will walk you through the process of completing the form online, ensuring that you understand each section clearly.

Follow the steps to complete the authorization records release form online.

1. To begin, press the ‘Get Form’ button to obtain the document and open it in your online editor.
2. In the first section labeled 'Patient's Name,' please print your full name clearly as it appears in your official records.
3. Move to the next line, 'Name of Person being Authorized,' and print the full name of the individual to whom you are granting access to your medical records.
4. Read the statement regarding the authorization carefully. This section informs you that you are allowing the authorized person to receive and review all medical records, documentation, billing, and other records maintained by Pierpont Family Medicine.
5. Locate the date field and enter the current date when you are filling out the form.
6. Finally, in the 'Patient's Signature' field, sign your name to confirm your authorization. If you are using an online form, follow the instructions to insert a digital signature if required.
7. Once all fields are completed, ensure to save your changes. You can then download, print, or share the form as needed.

Start completing your Authorization Records Release form online today for better management of your medical records.