Follow the steps to successfully complete your M3132 form.

1. Click the ‘Get Form’ button to acquire the M3132 form and open it in your preferred editor.
2. In Part A, enter patient information such as the patient's name, phone number, email address, and home address. Be sure to include the patient's date of birth and the last four digits of their Social Security number, as well as the medical record number.
3. In Part B, indicate the person or company who will receive the information. If the patient is the recipient, select the corresponding option. Otherwise, provide the name, phone number, address, email, and fax number of the designated recipient.
4. Part C requires you to specify the information to be released. You can select treatment dates, individual records, or opt for the entire medical record. Check all relevant boxes to clearly indicate what information is needed.
5. In Part D, state the purpose of the request by checking the appropriate option such as personal, legal, insurance, continuation of care, or other. Provide a brief explanation if needed.
6. Part E details how you want the information delivered. Choose from electronic delivery options like MyChart or encrypted email, or select mail delivery methods, including CD, thumb drive, or paper.
7. Review Part F where you acknowledge the release of sensitive information, if applicable. Check all relevant boxes and understand your rights regarding revocation and re-disclosure.
8. Finally, sign and date the form in the designated area. If someone is signing on behalf of the patient, provide their printed name and relationship to the patient.
9. If applicable, complete the optional witness section in Part G and ensure any authority documents are attached. After completing the form, you can save changes, download, print, or share it.

Complete your NC Duke Health M3132 form online today for a smooth experience in managing your health information.