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Dr Gregory Hrasky, MDMesa, AZ 85202Pediatric

Dr Gregory Hrasky, MDMesa, AZ 85202Pediatric 2026

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The document is an authorization form from Cactus Pediatric Orthopaedics, specifically for Kids' Fracture Care, allowing the release of healthcare information. It includes sections for patient details, types of information to be released, purposes for the release, and legal disclaimers regarding privacy and revocation rights. The form must be signed by a parent or legal guardian and expires 90 days after signing.

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Click ‘Get Form’ to open the Dr Gregory Hrasky Pediatric Authorization form in the editor.
Begin by entering the Patient’s Name and Date of Birth in the designated fields. This information is crucial for identifying the correct medical records.
Fill in the Address, City, State, and Zip Code of the patient to ensure accurate communication regarding the release of information.
Select whether you authorize the release of all healthcare information or specify particular treatments or conditions by filling in the relevant section.
Indicate your preferred method for receiving records (e.g., paper records, faxed records) and state the purpose of this release from options provided.
Complete the section detailing where to send the information by providing the Name, Address, City, State, Zip Code, and Telephone Number of the recipient.
Finally, ensure that a Parent/Legal Guardian prints their name, signs, and dates at the bottom of the form to validate this authorization request.

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