AUTHORIZATION FOR THE RELEASE OF RECORDS TO TOC 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, Social Security Number (SSN), and date of birth (DOB) in the designated fields. This information is crucial for identifying the records to be released.
3. In section one, provide the complete name and address of each person or agency that possesses the medical records. Include the date of treatment for each problem treated, ensuring accuracy for proper record retrieval.
4. Next, specify The Orthopaedic Center as the recipient of the records by confirming their address and contact details provided in the form.
5. Finally, ensure that both the patient and a witness sign and date the form at the bottom. This step is essential for validating your authorization.

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