Maryland authorization obtain health 2025

1. Click ‘Get Form’ to open the Maryland Authorization to Obtain Health in the editor.
2. Begin by entering your full name in the 'CLIENT NAME' section, including last, first, middle initial, and any maiden or other names.
3. Fill in your date of birth and social security number in the designated fields. Ensure accuracy for proper identification.
4. Provide your current address, including city, state, and zip code. This information is crucial for correspondence.
5. Enter your daytime and evening phone numbers for contact purposes.
6. Select one of the options to either allow Planned Parenthood of Maryland to release information or request information from an outside healthcare provider. Fill in the respective names and addresses as required.
7. Specify the health information you wish to be released by checking the appropriate boxes. You can also add any additional details if necessary.
8. Review the conditions of authorization carefully before signing. Make sure you understand your rights regarding revocation and expiration of this authorization.
9. Sign and date the form at the bottom. If applicable, a parent or legal guardian should also sign.

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