Get Des Moines University Clinic Authorization For Release Of Medical Information 2018-2025

Filling out the Des Moines University Clinic Authorization for Release of Medical Information is a straightforward process that enables users to request the release of their medical records. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the authorization form online.

1. Press the ‘Get Form’ button to access the authorization form, allowing you to open it in your editing tool of choice.
2. Begin by filling out the patient’s information, including their name, identification number, and date of birth. Ensure that all provided information is accurate.
3. Identify the entity that will disclose the information by entering the name and contact details for Des Moines University or another health care provider.
4. Specify the individual or entity that is authorized to receive the medical information, providing their name, address, and phone number.
5. Indicate which specific medical information you are requesting for release by checking the applicable boxes, such as ‘entire medical record’, ‘immunizations’, or specific provider records.
6. State the purpose of the authorization by selecting the corresponding reason from the options given, such as transferring medical care.
7. Review the section that involves the release of protected information. You must check ‘Yes’ or ‘No’ for each type of sensitive information you are authorizing for release.
8. Choose your preferred format for receiving the information, whether by paper, electronic means, or other methods. Fill in any required details, such as an email address if applicable.
9. Sign and date the form at the bottom to validate the authorization. If a legal representative is signing, provide their relationship to the patient.
10. Finalize the process by reviewing all fields for accuracy and ensuring no sections are left incomplete. You may then save your changes, download, print, or share the completed form as needed.

Complete your authorization document online today.