Get Hershey Medical Center Medical Release

Filling out the Hershey Medical Center Medical Release online is a crucial step in obtaining access to your medical records. This guide provides clear instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the medical release form

1. Press the ‘Get Form’ button to access the medical release form and open it for editing.
2. Fill in the name of the patient in the designated field, ensuring accurate spelling and formatting.
3. Enter the date of birth of the patient in the corresponding section to verify identity.
4. Provide the patient's phone number to facilitate communication regarding the medical records.
5. Select the information to be disclosed from your medical record. Take note that this can include sensitive information, such as HIV/AIDS, drug and alcohol abuse, and mental health data.
6. Indicate to whom the medical records should be released by filling in the name of the authorized person, agency, or institution.
7. Complete the street address, city, state, and zip code for the recipient to ensure accurate delivery.
8. Choose the format in which you would like to receive the medical records, such as paper, CD, or via the internet.
9. Provide a reason for the request in the designated section, ensuring that your reasoning aligns with the disclosure requirements.
10. Check the boxes for the types of medical records you are requesting and list the dates of service related to those records.
11. Sign the form in the section provided, indicating your understanding and authorization of the request.
12. Enter the date you sign the document to validate the request.
13. If signed by someone other than the patient, include the relationship to the patient in the indicated field.
14. Review all information provided to ensure accuracy before submission.
15. Finalize the process by saving any changes made to the document. You may also choose to download, print, or share the completed form.

Complete your medical release form online today to ensure timely access to your important health information.