Get Pace West Pt

This guide provides a comprehensive overview of how to fill out the Pace West Pt medical records release form online. Whether you are experienced with digital forms or new to the process, this guide aims to support you through each step.

Follow the steps to accurately complete the Pace West Pt form online.

1. Click ‘Get Form’ button to access the medical records release form and open it for editing.
2. In the ‘Date’ field, enter the current date. This helps to document when the consent was given.
3. In the ‘Patient’ field, fill in your full name. This identifies you as the patient whose records are being requested.
4. In the section labeled ‘Physician/Department,’ list the name of the physician or department that will receive your medical records.
5. Complete the address section by providing the full address of the physician or department you listed in the previous step.
6. Fill out the ‘Phone’ field with the contact number for the physician or department to ensure correct communication.
7. If applicable, complete the ‘Fax’ field with a fax number where your records may be sent.
8. In the ‘Patient Name Printed’ section, clearly print your name to confirm your identity on the document.
9. Enter your date of birth in the specified field to further verify your identity.
10. Sign in the ‘Patient Signature’ area. This signature serves as your consent for the release of your medical records.
11. Finally, enter the date again in the last field to indicate when you signed the form.
12. Once you have completed all sections, review the form for accuracy. After confirming that all information is correct, you can save the changes, download a copy, print it, or share it as needed.

Complete your medical records release form online for a smooth and efficient process.