The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Release Of Information For Mental Health In Wake
Category:
State:
Multi-State
County:
Wake
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
WakeMed is a large, off-campus teaching site for the UNC School of Medicine — an affiliation that has been in place for over 40 years. Many physicians in the WakeMed community have graduated from medical education programs at UNC. Around 50 residents rotate at WakeMed — most from UNC with a few from Duke University.
Fax Numbers: Cary Hospital: 919-350-2285. North Hospital: 919-350-6892.
As Wake County's only provider of trauma services and a regional trauma referral center, our two trauma centers — a Level I Trauma Center at Raleigh Campus and a Level III Trauma Center at Cary Hospital — and the WakeMed Trauma teams are standing ready to provide immediate care for the seriously injured.
For immediate continuity of care requests, you or your health care provider can request that records are sent directly to their office. Use the form above, or your provider's office can fax a written request on business letterhead to 619-543-7128.
Phone Directory Department namePhone number Main Phone 469.764.8000 Business Office/Billing Questions 214.820.2278 Medical Records 469.764.9110 | Fax: 469.764.9118 Physician Referral 1.844.BSW.DOCS (1.844.279.3627) (1.844.279.3627)2 more rows
How you make your request will depend on your provider's processes. You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access—send an email, or mail or fax a letter to your provider.
