Get Mercy Health Records Release 2012-2025

Filling out the Mercy Health Records Release is an important step in managing your healthcare information. This guide provides clear and supportive instructions to help you complete the form accurately and effectively.

Follow the steps to fill out the Mercy Health Records Release form online.

1. Click the ‘Get Form’ button to access the Mercy Health Records Release form and open it for editing.
2. In the first section, enter the patient's name where indicated. Ensure this is the full legal name to avoid any issues with processing.
3. In the next field, specify the organization authorized to release the records. This could be any medical facility, clinic, or healthcare provider.
4. Provide the date of birth of the patient to further identify them and authenticate the request.
5. In the section listing the types of records to be released, check all applicable boxes. Options include History and Physical, Office Notes, Test Results, Consultations, Other, or Complete Medical Chart.
6. If you selected 'Other,' please specify the type of records in the provided space.
7. Indicate any exclusions to the information requested, if applicable, in the specified area.
8. Fill in the recipient's information carefully, including name, address, city, state, zip code, phone number, and fax number.
9. Review the authorization disclaimer, which states that signing this release is voluntary and not a requirement for treatment.
10. Sign and date the form in the designated areas. If there is another person legally authorized to give consent, they should sign as well and indicate their relationship.
11. Once all fields are completed, save any changes made to the document. You can then download, print, or share the completed form as needed.

Complete your Mercy Health Records Release online today for seamless management of your health information.