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Click ‘Get Form’ to open the Authorization for Release of Medical Information in the editor.
Begin by filling in your personal details, including your name, date of birth, address, and phone number. Ensure accuracy as this information is crucial for identification.
In the 'Release Records To' section, specify where you want the medical records sent. You can choose to have them mailed, faxed, or picked up in person.
Indicate the specific medical records you wish to request by checking the appropriate boxes under 'Information Requested.' If applicable, specify dates of treatment.
Review the authorization statements carefully. Initial next to your choice regarding the release of sensitive information and sign at the bottom of the form.
Once completed, submit your signed form via hand delivery, mail, or fax as instructed on the document.
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