Get Authorization For The Release Of Bmedicalb Record Information - Childrenshospital

Filling out the authorization for the release of medical record information is a crucial step in ensuring that you or your child’s medical history is shared appropriately with authorized individuals. This guide will provide you with a detailed, step-by-step approach to completing this form online, ensuring that all necessary information is accurately provided.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the authorization form in your preferred digital format.
2. Begin filling out the demographics section with the patient's last name, first name, middle initial, and date of birth. Make sure to include their home address, telephone numbers, and medical record number if applicable.
3. In the next section, you will need to provide the name and address of the person or facility to whom the medical records should be released. Include any pertinent contact information such as attention and telephone number.
4. Select the purpose of the release by checking the appropriate box. Options include medical care, school or camp, insurance, personal reasons, or legal matters. Be sure to consult the notice regarding potential copying fees for certain requests.
5. Indicate the preferred format for the release of information by checking either CD, paper, fax (to a medical office), or specify another format if needed.
6. Outline the specific information you are requesting. You can choose to request the entire medical record, a medical record abstract, or specify other information such as consultation reports or test results. Don’t forget to include the date range if applicable.
7. Proceed to page 2 of the form. Review the items for which you are granting permission to be released. Initial each relevant item to indicate your consent.
8. Finally, sign the form where indicated, including the date and, if necessary, the signature of a parent or guardian if the patient is under 18. Ensure all information is correct before finalizing.
9. Once you have completed the form, you can save the changes. Then, choose to download, print, or share the completed document as needed.

Complete your documents online today for a smooth process in releasing medical records.