This form is a consent to the release of medical history. The patient authorizes the release of his/her medical history to the specified party within the consent release form. The form also provides that all prior authorizations are cancelled.
Authorization Release Form For Medical Records In Tarrant
State:
Multi-State
County:
Tarrant
Control #:
US-00460
Format:
Word;
Rich Text
Instant download
Description
Free preview
Form popularity
FAQ
Kendall Crowns - Chief medical examiner - Tarrant County | LinkedIn.
For further questions, contact the Records Department at 817-920-5700. PLEASE NOTE: A separate check is required for each record type requested.
You may obtain a copy of an autopsy report by submitting a letter by mail or email jp3_main@mctx requesting the copy. Please include the name of the deceased and the date of death, along with your contact information. Family members are not charged for the first copy. Charges may apply for additional copies.
If you have questions about any matter that is not answered on our County Webpages, the Frequently Asked Questions Page or these phone numbers, please call the County Telephone Operator at 817-884-1111.
Content for a valid authorization includes: The name of the person or entity authorized to make the request (usually the patient) The complete name of the person or entity to receive the protected health information (PHI) A specific description of the information to be used or disclosed, including the dates of service.
9-1-1 is for EMERGENCY situations. Tarrant County Sheriff's Communications Section provides a link between the citizens and emergency assistance units. The 9-1-1 system is one of the most state-of-the-art phone systems. The NON-EMERGENCY phone number is 817-884-1213. For all JAIL information call 817-884-3000.
Release of Information Authorization Under the HIPAA Privacy Rule, when a release of information is intended for purposes other than medical treatment, healthcare operations, or payment, you'll need to sign an authorization for ROI.
Content for a valid authorization includes: The name of the person or entity authorized to make the request (usually the patient) The complete name of the person or entity to receive the protected health information (PHI) A specific description of the information to be used or disclosed, including the dates of service.
Tips to Write an Authorization Letter Use the Formal Business Letter Format. Define Purpose and Authorization Details. Use Professional and Polite Language. Include Contact Information. Give Proper Closure with Signature and Date.
The format of an authorization letter should include the date, the name of the person to whom it is addressed, details about the person who has been authorized (such as name and identity proof), the reason for his absence, the duration of the authorized letter, and the action to be performed by another person.