Get Ny Nyu Langone Medical Center Records Release Authorization 2014-2025

Filling out the NY NYU Langone Medical Center Records Release Authorization is a straightforward process that enables you to authorize the release of your medical records. This guide provides detailed instructions to help you complete the form online with ease and confidence.

Follow the steps to fill out your records release authorization form effectively.

1. Press the ‘Get Form’ button to access the NY NYU Langone Medical Center Records Release Authorization form and open it in your editor.
2. Fill in the 'To' section by specifying the recipient of the records, in this case, enter 'Neurology Associates / Pearl Barlow Center NYU Langone Medical Center'.
3. In the section provided, check all relevant programs that you authorize to receive your information, such as 'Clinical Trials Program' and 'NYU Alzheimer’s Disease Center'.
4. Specify the complete history records by writing the time period for which your medical condition and/or treatment records are required. Enter this information in the designated spaces for dates.
5. Input your full name in the designated area to confirm your identity as the person authorizing the release.
6. Provide your current address as required, ensuring all details are accurate for communication purposes.
7. Enter the date of filling out the form in the specified field.
8. Sign the form in the signature section to provide your authorization for the record release.
9. If applicable, indicate your relationship to the individual if you are signing as a relative or proxy.
10. A witness should sign in the witness section if required or specify if they are not needed.
11. Finally, after reviewing all the information for accuracy, you can save your changes, download the completed form, print it, or share it as necessary.

Complete your documents online today to authorize the release of your medical records.