Get Authorization For Release Of Medical Records Ogc-2012-09.pdf

This guide provides comprehensive instructions on how to complete the Authorization For Release Of Medical Records OGC-2012-09.pdf online. By following these steps, users can ensure that they accurately fill out the required information for medical records release.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by entering the name of the patient in the designated field. Ensure that the name is printed clearly and accurately.
3. Next, enter the patient's date of birth in the format provided, which is usually month/day/year. This helps to identify the correct medical records.
4. Input a contact phone number in the designated field for any follow-up communications regarding the request.
5. In the section labeled 'Information to be released,' mark all relevant checkboxes that indicate which records you would like to request. This may include options such as history and physical records, radiology reports, or other pertinent documents.
6. If certain sensitive information needs to be disclosed, such as substance abuse or mental health records, please check the appropriate boxes to give specific authorization.
7. Indicate where the records will be sent by providing the name of the organization receiving the records, followed by their complete address. Repeat this process for the organization from which records are to be obtained.
8. Select the purpose for which the medical records are needed by marking the relevant options. This could be for continuing medical care, insurance, or legal purposes, among others.
9. Read the accompanying privacy statements carefully. This section informs you about the confidentiality of the records and the limits of liability concerning their release.
10. Sign the form at the bottom, indicating that you acknowledge and understand the authorization given. Include the date of your signature and printed name.
11. After completing the form, save your changes to ensure all information is stored. You may choose to download, print, or share the form as necessary.

Complete your documents online and ensure your medical records are accurately released.