West hills hospital medical records 2025

1. Click ‘Get Form’ to open the west hills hospital medical records in the editor.
2. Begin with Section A, entering the Patient Name, Birth Date, and Phone Number. If you wish, include the last four digits of your SSN.
3. Fill in the Provider's Name and Recipient's Name along with their respective addresses. Ensure all details are accurate for proper processing.
4. Select your preferred Request Delivery method: Paper Copy, Electronic Media, Encrypted Email, or Unencrypted Email. Be aware of the risks associated with unencrypted options.
5. Specify the expiration date or event for this authorization and describe the purpose of disclosure clearly.
6. Indicate if this request includes psychotherapy notes and check any additional items you wish to disclose from the list provided.
7. In Section C, sign and date the form. If applicable, print your name and relationship to the patient.

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