Get For Official Use Only - Rush University Medical Center - Rush 2015-2025
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How to fill out the For Official Use Only - Rush University Medical Center - Rush online
Completing the For Official Use Only - Rush University Medical Center - Rush form online is a straightforward process designed to facilitate the release of your patient health information. This guide will provide you with clear, step-by-step instructions to assist you in filling out the necessary sections accurately and efficiently.
Follow the steps to fill out the form correctly.
- Press the ‘Get Form’ button to obtain the form and open it in your editor.
- Fill out the 'Patient Information' section by providing your full name, including your maiden name if applicable, date of birth, and phone number. Ensure to provide your complete address, including city, state, and zip code.
- Indicate the medical information you are requesting by checking the appropriate box or filling in the name of the individual or organization from which you are requesting records. If applicable, include their phone number and address.
- Specify the recipient of the medical information under 'Release Requested Medical Information To.' Fill out the necessary details if the requestor is not the same as the patient.
- Select the purpose of the request by checking one or more appropriate boxes, such as 'Continuation of Care' or 'Insurance.' If other, specify your reason.
- Fill in the dates for which you are requesting medical records. Provide the start and end dates in the specified format.
- Select your type of visit by checking the corresponding box. Include any relevant department or facility details.
- Indicate which specific medical information you are requesting by checking the boxes of the relevant documents like 'Discharge Summary' or 'Lab Reports.'
- If additional information is required, check the corresponding boxes and provide initials and dates where required for genetic testing, drug/alcohol information, HIV status, and mental health.
- Review the authorization statements carefully. By signing, you confirm your authorization and acknowledge your rights under this request.
- Sign and date the form as either the patient or a personal representative. Ensure to provide the relationship to the patient if applicable.
- If required, have the witness sign the form, providing their name, relationship to the patient, and phone number.
- Once all sections are completed, you can save your changes, download, print, or share the form as needed.
Complete the required documents online for the efficient management of your health information.
A clinic coordinator at Rush University Medical Center earns a salary that is competitive within the healthcare industry. Salaries can depend on experience, responsibilities, and the specific department. This role is vital in managing daily operations and ensuring smooth patient flow, which ultimately enhances patient care at Rush. For Official Use Only - Rush University Medical Center - Rush recognizes the significance of this position in achieving operational excellence.
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