BMEDICAL RECORDb - Patient First 2026

1. Click ‘Get Form’ to open the BMEDICAL RECORDb - Patient First in the editor.
2. Begin by entering your personal information. Fill in your name, date of birth, and the last four digits of your Social Security number in the designated fields.
3. In the 'Authorization for Release of Information' section, specify the name of the provider you are authorizing to release your medical records.
4. Complete the recipient's details by filling in their name, address, city, state, zip code, and phone number.
5. Select which information you wish to be released by checking the appropriate boxes for Medical Record, X-rays, EKG, Itemized Statement, or Other.
6. Indicate the purpose of disclosure by selecting from options such as Continuing Care or Insurance. You may also specify other reasons if necessary.
7. Finally, sign and date the form at the bottom. If someone else is signing on your behalf, provide their relationship and legal authority.

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