Get Vcu Health System H-mr-0373 2021-2025

Filling out the VCU Health System H-MR-0373 form online is essential for authorizing the release of your confidential health care information. This guide will provide clear steps to help you navigate each section of the form effectively.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the H-MR-0373 document and open it in your preferred online editor.
2. Begin by filling in your full name in the space provided. This is essential for identifying the patient whose records are being released or obtained.
3. Indicate whether you are authorizing VCU Health System to release your health information or to obtain information from another provider by checking the appropriate box.
4. In the next section, provide the name of the person, provider, institution, attorney, school, or other entity to whom the information will be released or obtained. Include the full address and contact information of this recipient.
5. Select the types of information that you wish to be released or obtained by checking the relevant boxes, such as discharge summaries or laboratory reports.
6. Specify the approximate service dates relevant to your medical records request.
7. Choose the method for how your records should be delivered, with options like electronic mail or physical copies. Indicate your preference clearly.
8. Review the section about revocation of this authorization, ensuring you understand your rights regarding the release of your health information.
9. Sign and date the form where indicated. If someone other than the patient is signing, clearly state the legal authority of that individual.
10. Once all sections are completed, you can save the changes made to the form. You will have the option to download, print, or share the completed document as needed.

Take action now by completing your VCU Health System H-MR-0373 form online.