Get Lahey Authorization For Release Form

The Lahey Authorization For Release Form is essential for authorizing the release of your medical records. This guide provides clear, step-by-step instructions to help you complete the form online securely and efficiently.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to obtain the Lahey Authorization For Release Form and open it in your document editor.
2. Provide your patient information. Print your full name, date of birth, and address. Include your phone number and work phone if applicable.
3. Indicate where the medical records should be sent. Select the appropriate facility and fill in the name and address of the recipient, including attention to any specific person if necessary.
4. Specify the method of delivery by checking the appropriate box for mailing, picking up, faxing, or emailing.
5. Detail the specific information you need released by checking the appropriate boxes and providing any necessary comments or dates.
6. State the purpose of your request by selecting one or more reasons provided in the list.
7. If applicable, initial the lines to authorize the release of protected or sensitive information such as psychiatric notes or information related to substance abuse.
8. Complete the form by ensuring all necessary fields are filled out, including your signature, date, and any documents required for legal relationships.
9. Review the completed form carefully, then save your changes, download, print, or share the completed form as needed.

Start filling out the Lahey Authorization For Release Form online today to ensure smooth access to your medical records.