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Release of information - Citrus Orthopaedic & Joint Institute 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient’s name and date of birth in the designated fields at the top of the form.
- Provide the Social Security Number (SS#) in the appropriate section to ensure accurate identification.
- In the 'Release Information To' section, fill in the name and address of the individual or organization receiving the information.
- Complete the phone and fax number fields for efficient communication regarding this release.
- Specify the reason for disclosure clearly, ensuring it aligns with your needs for sharing medical information.
- Review and understand the authorization statement regarding what information is being released, including any sensitive data.
- Sign and date the form as either the patient or legal representative, indicating your relationship if applicable.
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| Versions | Form popularity | Fillable & printable |
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| 2017 | 4.9 Satisfied (57 Votes) |
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Related links
Charlotte, N.C.. Completion Year: 2018. Currently Practicing: Orthopedic Spine Surgeon. Citrus Orthopaedic and Joint Institute. Lecanto, Fla.Read more
Mailing Address, 4500 NEWBERRY RD GAINESVILLE, FL 32607-2245. United States Phone: 352-336-6000 | Fax: View Map ; Primary Practice Address, 70 N LECANTO HWY