Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Medical Authorization Form For Minor In Fulton
Category:
State:
Multi-State
County:
Fulton
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
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By signing this authorization form, you are agreeing to the release or disclosure of your protected health information. These are the official forms for use in Family Court proceedings.Use the form below to do so. This ensures that we are able to receive medical records pertaining to your next appointment. Please download and sign this form and send to your child's prior pediatrician to request your child's medical records be sent to North Fulton Pediatrics. A parental consent form is required for all children receiving medical care or dental care, with the exception of adolescents receiving sexual health services. The FCMC Patient Portal is an online tool where you can access your own health information without the need to contact the Medical Records Department.