Get Des Moines University Clinic Authorization For Release Of Medical Information 2010

Filling out the Des Moines University Clinic Authorization For Release Of Medical Information form online can streamline the process of obtaining or sharing medical records. This guide provides step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to fill out the form online with ease.

1. Use the ‘Get Form’ button to access the document and open it in your preferred editor or viewer.
2. Begin by filling in the patient's name in the designated field: 'The Medical Records Of: (Patient name).'
3. Provide the patient's address, including city, state, and zip code, in the corresponding fields to ensure accurate identification.
4. Enter the patient's date of birth in the provided field to help verify their identity.
5. Fill in the patient's phone number in the space provided for contact purposes.
6. Select whether you would like to send medical records to someone or obtain them from another source by checking the appropriate box.
7. If obtaining records, fill in the name and address of the organization or individual from whom you are obtaining records, along with their phone number and fax number.
8. Specify the types of medical information being released by checking the relevant boxes, such as progress notes, billing, lab results, or other pertinent documents.
9. Indicate the reason for the release of information by checking the appropriate box, such as insurance, legal, or medical care.
10. Review the effective date of authorization and understand that it lasts for one year unless otherwise specified.
11. Both the patient or legal representative must sign the form. Ensure signatures are provided in the designated areas along with the date.
12. Finally, save changes, download, print, or share the completed form as needed.

Complete your forms online today to expedite the process of managing your medical information.