Get Al The Orthopaedic Center Authorization For The Release Of Medical Information And Records 2019-2025

Filling out the AL The Orthopaedic Center Authorization For The Release Of Medical Information And Records form online is an essential step in ensuring that your medical information is shared appropriately. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your authorization form.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the patient's full name in the designated field. Ensure that the name matches the official identification documents.
3. Provide the patient's Social Security Number (SSN) in the appropriate section. This is crucial for identifying the correct medical records.
4. Fill in the date of birth (DOB) for the patient. This information is important for verifying identity.
5. Specify the complete name and address of the person or agency in possession of the medical records. Include any relevant contact information.
6. Indicate the date of treatment for each problem addressed in the medical records. This helps to contextualize the information being released.
7. Repeat steps 5 and 6 for each additional person or agency with relevant medical records, noting the treatment dates accordingly.
8. Clearly write the name and address of the entity receiving the records, which is The Orthopaedic Center located at 927 Franklin Street, Huntsville, AL 35801.
9. Sign the form in the section marked ‘Patient Signature’ to authorize the release of your medical information. Ensure the date of the signature is also included.
10. If applicable, have a witness sign and date the form in the designated spaces.
11. Once all sections are completed, review the form for accuracy. Then, you can save your changes, download, print, or share the completed form as needed.

Complete your authorization form online today for seamless processing of your medical records.