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Get Umhs 70-10015 2012
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How to fill out the UMHS 70-10015 online
The UMHS 70-10015 form is used to authorize the release of medical records from the University of Michigan Health System. This guide will provide clear, step-by-step instructions to help users effectively complete the form online.
Follow the steps to complete the UMHS 70-10015 online form.
- Click ‘Get Form’ button to access the UMHS 70-10015 form and open it in the appropriate online format for filling out.
- Complete the authorization section. Enter your full name, any other names you are known by (such as maiden name), date of birth, address, medical record number (UMHS MRN), and contact information including telephone number and email address.
- Indicate if you are requesting information for yourself or another individual. If you are requesting for another person, provide their details in the section labeled 'Other' and ensure you have the necessary authorization.
- Select the method for receiving the documents, such as eDelivery, US Mail, or Certified Overnight Delivery. Ensure you provide the necessary details for the selected method.
- State the purpose for the release of your health information by choosing from the provided options, such as continuation of care or legal reasons.
- Select the record set you wish to be released and specify any relevant dates if necessary. This can include clinical documentation, billing information, or specific lab reports.
- Specify the expiration date of the authorization or note that it will expire 60 days from the date of signing if left blank.
- If applicable, provide the signature of the patient or legally authorized representative along with the printed name and relationship to the patient.
- Review the completed form for accuracy, then save changes. You can then download, print, or share the form as needed.
Complete your UMHS 70-10015 form online today to efficiently manage your medical records.
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Yes, medical records can generally be faxed, but specific rules may apply depending on privacy regulations. Typically, you'll need to authorize the release of your records, and your healthcare provider should guide you through this process. If you need to send records related to UMHS 70-10015, make sure to confirm with your provider that they can accommodate fax requests securely.
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