Cdcr 7385 form-2025

1. Click ‘Get Form’ to open the CDCR 7385 form in the editor.
2. Begin with Section I, 'Patient Information.' Fill in your last name, middle name, first name, CDCR number, date of birth, and address. If you are currently incarcerated, you may leave the address blank.
3. In Section II, provide the name and address of any individual or organization authorized to release personal health records if it is not CDCR.
4. Proceed to Section III to specify who will receive the information. Enter their name, relationship to you, phone number, and address.
5. For Section IV, indicate an expiration date for this authorization or an event that will trigger its expiration. If left blank, it will be valid for 12 months from signing.
6. In Sections V and VI, select which health care records you wish to release by checking the appropriate boxes and providing date ranges where required.
7. Complete Section VII by checking at least one purpose for releasing your information. You can also specify 'Other' if needed.
8. Review Section VIII for important patient rights regarding this authorization before proceeding to sign in Section IX.
9. Finally, sign and date the form in Section IX. If someone else is signing on your behalf, ensure they provide their details as well.

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