Get Ma Cambridge Health Alliance Authorization For Release Of Medical Records 2017

Filling out the MA Cambridge Health Alliance Authorization For Release Of Medical Records online is a crucial step in managing your health information. This guide provides clear instructions, enabling you to complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Use the ‘Get Form’ button to access the MA Cambridge Health Alliance Authorization For Release Of Medical Records form. This will allow you to open and edit the document online.
2. Begin by filling in your patient information. Enter your last name, first name, date of birth, home address, city, state, zip code, cell phone number, and any other contact number. Ensure accuracy in these details as they identify you as the patient.
3. In the section titled 'Release Information to', provide the details of the person or facility you wish to receive your medical records. Fill out their name, address, city, state, zip code, attention (if applicable), and phone and fax numbers.
4. Select the purpose of disclosure by checking the applicable boxes such as Medical Care, Insurance, Legal, Personal, or Other. This clarifies why you are requesting the release of your medical records.
5. Specify the format of the release by choosing between paper or fax delivery. Note that faxing is typically only for medical providers.
6. Indicate which information you would like to be released by checking the appropriate boxes. This may include the entire record, clinic visit notes, photographs, pathology reports, and more. Be sure to specify the dates for the records if needed.
7. If highly sensitive information is to be included, initial next to each specific category of sensitive health information you authorize for release, such as HIV test results, mental health records, or substance abuse treatment.
8. Review the term of the authorization, which is set for one year unless specified otherwise. Ensure you enter the desired expiration date if you choose a date different from the default.
9. Finally, sign the document in the space provided and date it. If you are signing on behalf of an unemancipated minor or an incapacitated person, provide your signature and description of authority.
10. Once completed, you may save the changes, download, print, or share the completed form as required. Completed forms can be faxed or mailed to the specified address.

Complete your medical records release authorization online today for a seamless experience.