Get Ca Authorization For Release Of Patient Health Information 2021-2025

Completing the Authorization For Release Of Patient Health Information form is essential for obtaining medical records regarding physical therapy care. This guide provides a clear step-by-step process to help you fill out the form correctly and efficiently online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the form and open it in your online editor.
2. Enter the patient’s name, date of birth, and medical record number if known. If the patient has passed away, provide their date of death.
3. Fill in the name of the physical therapist or assistant involved in the care, along with the facility name, address, and phone number.
4. Specify the treatment date(s) that pertain to your request for records.
5. Ensure the form is signed and dated by the patient or an authorized individual, such as a parent or legal representative. Include the relationship of the signer to the patient.
6. Review the completed form to ensure all fields are accurate and no additional comments have been added, as this may void the authorization.
7. Once completed, save your changes, and consider downloading or printing the form for your records. You can also share the form as necessary.

Complete your documentation online today!