Get Stevenson University Authorization To Release Patient Medical Information 2018-2025
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How to fill out the Stevenson University Authorization to Release Patient Medical Information online
Filling out the Stevenson University Authorization to Release Patient Medical Information form online can be a straightforward process when guided properly. This user-friendly guide will walk you through each step to ensure you complete the form accurately.
Follow the steps to complete your authorization form online.
- Click the ‘Get Form’ button to access the authorization form and open it in your preferred document editor.
- Begin by entering your patient information. Fill in your name, SU ID number, any former name if applicable, date of birth, and contact phone numbers. Be sure to include your cell phone number as well as your initial term as a full-time student.
- Next, specify the purpose of your request by selecting one of the options listed: healthcare, transfer to college/university, personal, or other.
- Provide details of the information to be released or obtained. Specify the name of the student, provider, or facility that you authorize to release or obtain information, and fill in their address, city, state, and phone number.
- Indicate how long this authorization is valid. You can choose either for this request only or for one year from the date of signing.
- Select your preferred method for information release. Options include picking up records at the Stevenson University Wellness Center, mailing them to another address, or faxing them as needed.
- Specify the specific information you wish to be released, such as x-ray results, student health forms, lab results, flu shot records, or women's health annual results.
- Provide your signature and print your name. If you are under 18 years old, a parent or legal guardian must also sign and print their name.
- Finally, review all entries to ensure accuracy, then save any changes, download the completed form, print it for your records, or share it as needed.
Complete your Stevenson University Authorization to Release Patient Medical Information form online today for seamless processing.
To write an authorization to release medical records, include details such as the patient's name, the information to be released, and the recipients of that information. Utilizing a template for Stevenson University Authorization to Release Patient Medical Information simplifies this process. Ensure that the authorization is signed and dated for it to be valid.
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