Medical Records Release Form - Doctor Care Arizona 2026

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The document is a Medical Records Release Form from DoctorCare, located in Cave Creek, AZ. It authorizes the release of specific medical records for a patient, including radiology reports, lab results, and confidential information related to HIV, substance abuse, mental health, and genetic testing. The form requires the patient's signature and provides contact details for DoctorCare.

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Click ‘Get Form’ to open the Medical Records Release Form in our editor.
Begin by entering your personal information in the designated fields. Fill in your name, birth date, address, city, state, zip code, and contact numbers (home, business, and cell).
In the 'Records Release Authorization' section, review the statement carefully. By signing here, you authorize DoctorCare to receive your medical records as specified.
Next, specify the medical records you wish to be released for the past 18 months. This includes various reports such as radiology and lab results. Ensure you check all applicable boxes.
Sign and date the form at the bottom. Remember that a photocopy of this authorization is acceptable.
Finally, ensure that all information is accurate before submitting it via mail to the address provided at the top of the form.

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Versions	Form popularity	Fillable & printable
2008	4 Satisfied (23 Votes)

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