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Completing the Advanced Urology Institute - Homosassa Office - Advanced form online can streamline the process of requesting your health information. This guide will provide clear and straightforward instructions to help you fill out the form efficiently and accurately.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and access it for filling out.
2. Begin by entering the patient full name in the designated field. Ensure the name is spelled correctly to avoid any processing delays.
3. Input the patient email address in the relevant section. This allows for communication regarding the status of the request.
4. Provide the complete patient address, including the city, state, and zip code. Double-check for accuracy.
5. Fill in the patient's date of birth in the required format.
6. Enter the patient phone number in the designated field, ensuring the number is active for any follow-up communications.
7. In the section labeled 'Name/Facility', note the specific name or healthcare facility to which the information should be sent.
8. Provide the attention, address, city, state, zip code, and phone number of the facility in the respective fields.
9. Indicate the purpose of the request in the designated space. This can help clarify why the information is needed.
10. A series of checkboxes pertain to sensitive information. Mark the appropriate boxes for mental health, HIV tests, and substance abuse information as required.
11. Sign the patient authorization area, which includes the patient's signature and date. If applicable, a legal guardian must also sign.
12. Review the authorization to disclose health information section. Initial each line below it to confirm the understanding and acknowledgment of the terms.
13. Specify whether a two-year abstract of records is requested, adding any comments as necessary.
14. Select the preferred payment option for record copies, entering credit card details or specifying a mailing address for an invoice.
15. Once all sections are completed, users can save changes, download the document, print, or share the form as needed.

Ready to complete your request? Fill out the Advanced Urology Institute form online efficiently today.