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Get Westbrook Vision Center Plc Medical Records Release Form
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How to fill out the Westbrook Vision Center PLC Medical Records Release Form online
Filling out the Westbrook Vision Center PLC Medical Records Release Form is an essential step in accessing your medical history. This guide will help you navigate the process smoothly and ensure that all necessary information is provided efficiently.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the document and open it in your chosen editor.
- In the 'Date' section, enter the current date to document when you are completing the form.
- Fill in the 'Doctor Name' field with the name of the physician who will receive your records.
- Provide a fax number where the records should be sent in the 'Fax Number' section.
- In the authorization section, confirm your permission by writing 'I hereby authorize you to release my records to:' and specify the receiving doctors, Dr. Smith and Dr. Deemer.
- Complete the address for Westbrook Vision Center PLC, including the full address and contact information.
- Indicate the range of dates during which the information was collected by filling out the dates in the designated fields.
- If you have any special instructions, please use the section titled 'Special instructions' to provide any additional details that may assist in processing your request.
- In the 'PATIENT' section, print your name clearly and include your date of birth to identify yourself.
- Sign the form in the 'Signature' field to authorize the release of your medical records.
- After reviewing all the information for accuracy, save your changes and proceed to download, print, or share the completed form as needed.
Complete your documents online for a smooth and efficient process.
To mail medical records, it is best to use a reliable courier service that offers tracking and is familiar with handling sensitive documents. Completing the Westbrook Vision Center PLC Medical Records Release Form gives you a clear path to request documentation for mailing. This process ensures that your records are delivered safely and promptly.
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