Get Queen's Medical Center Authorization For Release Of Pathology Reports Slides And/or Specimens 1994-2025

Filling out the Queen's Medical Center Authorization for Release of Pathology Reports, Slides, and/or Specimens form is a straightforward process that allows users to request the release of important medical information. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the authorization form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your name in the designated field at the top of the form as the authorizing individual.
3. Provide the patient's name, birthdate, and address in the respective fields to specify the information related to the patient.
4. Input the date of treatment or surgery to indicate when the relevant medical services were provided.
5. Write the name and address of the recipient who will receive the released information in the 'To Be Sent/Released to' section.
6. Select the specimen requested by checking the appropriate boxes for 'Paraffin Blocks,' 'Microscopic Slides,' 'Breast Implant,' 'Bullets,' or 'Hardware,' and provide any labeling information as necessary.
7. Clearly state the purpose for the request in the designated area to provide context for the release of information.
8. Read the legal directions and authorization statement carefully, then sign and date the form in the appropriate section, ensuring it is completed by the patient, a parent, guardian, or personal representative as applicable.
9. Indicate your relationship to the patient if you are not the patient themselves, filling out the relationship field.
10. Provide the name of the personnel releasing the specimen and the dates where indicated.
11. Ensure that a witness signs and dates the form if required for validity.
12. Once all sections are completed, you can save changes, download, print, or share the form as needed.

Complete the authorization form online today to facilitate the release of important medical information.