Get Il Geneva Smiles Authorization For Release Of Dental Records And X-ray
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How to fill out the IL Geneva Smiles Authorization for Release of Dental Records and X-Ray online
Filling out the IL Geneva Smiles Authorization for Release of Dental Records and X-Ray form online is a straightforward process designed to ensure that your dental records are efficiently released. This guide provides clear, step-by-step instructions to help you complete the form accurately and securely.
Follow the steps to complete the authorization form online.
- Click the ‘Get Form’ button to access the IL Geneva Smiles Authorization for Release of Dental Records and X-Ray form and open it in the online editor.
- In the first field, enter the name of the patient or guardian who is authorizing the release of records. This should be printed clearly to avoid any confusion.
- Identify the doctor or the practice to whom you are authorizing the release of your dental health information by specifying their full name, street address, city, and zip code.
- Input the practice's telephone number and fax number. Ensure that these are correct to facilitate a smooth transfer of records.
- In the designated area, indicate the specific records you wish to be released. This includes current x-rays and treatment notes, as specified in the form.
- Sign the form, indicating your consent. Below your signature, print your name clearly to ensure proper attribution.
- Once all fields are completed, review the information for accuracy. After confirming that all details are correct, you can save changes, download, print, or share the completed form.
- Fax the completed form to the designated number, 888.288.3216, as instructed on the form.
Complete your IL Geneva Smiles Authorization for Release of Dental Records and X-Ray form online today for a hassle-free experience.
The legal owner of information within a patient’s record is primarily the healthcare provider or institution that generated the records. Patients, however, have the right to access and view their records. With the IL Geneva Smiles Authorization for Release of Dental Records and X-Ray, you can easily ensure your rights to your information are respected.
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