Release Of Medical Information Form Kaiser

State:
Minnesota
Control #:
MN-8555D
Format:
Word; 
Rich Text
Instant download

Description

A medical records (including mental health records) release authorization to obtain records for use in a dissolution proceeding.

How to fill out Minnesota Authorization To Release Medical And Mental Health Information?

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FAQ

What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.

Get started today at kp.org/requestrecords. For your convenience, you may request your records using phone, email, or by visiting any of our locations. Our offices are generally open from a.m. to 5 p.m. Locate the facility closest to you.

We assist your physician in completing your California Paid Family Leave certification. Before we can do this, you will need to obtain a doctor's note (caregiver report) that certifies the patient's need for a caregiver.

You can view them online or request electronic copies if you get care at a Kaiser Permanente medical office. You can also request your health information be sent to any person or entity. If you get care from a non-Kaiser Permanente provider, contact them to get copies of your record, or to have your record transferred.

Elements of a release formPatient information. Naturally, the release should require the patient's information so it's clear who the form refers to.Receiving party's information.Information to be shared.Purpose of the release.Expiration of authorization.Disclaimers.Date and signature.

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Release Of Medical Information Form Kaiser