Medical Records Release Form - Upstate OB-GYN Group - upstateobgyngroup 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information, including your name, address, date of birth, and social security number. This ensures that the records are accurately associated with you.
3. Select the specific Upstate OB-GYN location from which you wish to obtain records by checking the appropriate box.
4. Fill in the details of the doctor or office from which you are requesting information, including their name, address, and phone number.
5. Indicate how you would like to receive your records by selecting one of the options: mail, fax, or pick up.
6. Choose what type of information you want released by checking all applicable boxes such as medical records, lab reports, or prenatal records.
7. Specify the purpose for this disclosure by selecting from options like changing physician or insurance claim.
8. Review the authorization statement regarding sensitive information and select whether you authorize its release.
9. Finally, sign and date the form to complete your request. Ensure all fields are filled out correctly before submitting.

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