Resurgens medical records 2025

1. Click ‘Get Form’ to open the resurgens medical records in the editor.
2. Begin by filling out the 'Patient Identification' section. Enter your full name, date of birth, and the last four digits of your Social Security number. If applicable, include any maiden or other names.
3. In the 'Release Records To' section, specify the person or place where the records should be sent. Ensure you provide a complete address including city, state, and zip code.
4. Select the type of records requested by checking the appropriate boxes (e.g., medical records, films). Specify any additional details in the 'Other' field if necessary.
5. Indicate the purpose of release and provide a time frame for which records are needed by filling in the 'From' and 'To' dates.
6. Review and initial whether you authorize the release of sensitive information related to psychiatric conditions or substance abuse.
7. Sign and date at the bottom of the form. If someone else is signing on your behalf, ensure their relationship to you is noted.

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