Follow the steps to fill out the Rubino Ob Gyn Group online form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering the patient's first and last name in the designated field to identify the person whose records are being requested.
3. Fill in the patient's current street address, ensuring all information is accurate for proper correspondence.
4. Provide the city and state of the patient's residence to complete the address details.
5. Enter the patient's phone number in the specified field to ensure contact is possible if any issues arise during processing.
6. Input the patient's date of birth to verify their identity and confirm the age needed for medical records authorization.
7. Indicate the recipient for the medical records by filling out the name in the section provided.
8. Complete the recipient's address details for accurate delivery of the medical records.
9. Sign the form in the appropriate section to authorize the release of the requested medical records.
10. Date the form on the designated line to indicate when the authorization was given.
11. Finally, fax or email the completed medical request form using the provided contact information: Fax: 973-736-1834 or Email: medicalrecords@rubinoobgyn.com.

Complete your document submission online today for efficient processing.