Get Vcu Health System H-mr-0373 2013

Filling out the VCU Health System H-MR-0373 form is an essential step in authorizing the release or obtaining of your confidential health care information. This guide will provide you with clear instructions to ensure the form is completed correctly and efficiently.

Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Begin by printing your full name in the specified field to identify yourself clearly.
3. Enter your date of birth in the format of Month/Day/Year.
4. Provide your complete street address for accurate contact information.
5. Include your preferred phone number, either home or cell, to ensure communication.
6. If applicable, add your work phone number for additional contact options.
7. Fill in the name of the recipient or entity to whom the information is being released or obtained.
8. Complete the recipient's street address and city, state, and zip code for accurate delivery.
9. Optionally, provide a fax number if the request is solely for continuity of care.
10. Enter your email address, as your records will be available via a secure web portal.
11. In the designated area, authorize the release or obtaining of your health information by signing your name.
12. Specify the purpose for which the information is being requested, choosing from the provided options or writing in another purpose.
13. Sign and date the form to validate your request and ensure compliance with legal requirements.
14. Review the filled-out form for accuracy before saving your changes, and choose to download, print, or share the form as needed.

Complete your document online and ensure your health information is managed with care.