Get Colorado Brain And Spine Institute Request For Release Of Medical Information

Filling out the Colorado Brain And Spine Institute request for release of medical information form is a straightforward process that ensures you obtain your medical records efficiently. This guide will provide clear, step-by-step instructions tailored to help you complete the form correctly and with ease.

Follow the steps to fill out the form online.

1. Press the ‘Get Form’ button to access the form and open it in your editing application.
2. In the patient information section, print your full name clearly in the designated area.
3. Enter your date of birth in the specified field using the format MM/DD/YYYY.
4. Provide your social security number in the appropriate section, ensuring accuracy for identification.
5. In the physician/facility that is to release your records section, write the name of the healthcare provider or facility.
6. Complete the address field for the releasing facility, including street, city, state, and zip code.
7. Fill in the fax number of the releasing physician or facility, as this is necessary for the transmission of records.
8. Next, in the physician/facility that you want to receive your records section, repeat the entry process for the healthcare provider or facility receiving the records.
9. Ensure you include the name and complete address for the receiving facility, along with their fax number.
10. For the authorization for records release, check the box indicating that you authorize the release of all records or specify a range of records by filling in the dates.
11. Sign and date the form to finalize your request.
12. After completing the form, choose to save your changes, download, or print the document as needed.

Complete your document online now to ensure timely access to your medical information.