Loyola medical records 2026

1. Click ‘Get Form’ to open the Loyola Medical Records in the editor.
2. Begin by entering your Patient Name, Telephone Number, and Address in the designated fields. Ensure all information is accurate for proper identification.
3. Fill in your Date of Birth and the last four digits of your Social Security Number. This information is crucial for verifying your identity.
4. Select the facility from which you are requesting records by checking the appropriate box. If applicable, specify another facility in the provided space.
5. Indicate the name and address of the person or facility to whom you want your health information released.
6. Check all types of information you wish to be released under 'INFORMATION TO BE RELEASED'. Be sure to include any specific categories that apply in SECTION A.
7. Sign and date the authorization at the bottom of the form. If applicable, provide proof of relationship if you are signing on behalf of someone else.

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