Guthrie medical records fax number 2025

1. Click ‘Get Form’ to open the guthrie medical records fax number document in the editor.
2. Begin by filling in your personal details, including your name, maiden/previous name, date of birth, social security number, and medical record number. Ensure accuracy for proper identification.
3. In section 2, specify the organization authorized to disclose your health information by entering 'Robert Packer Hospital / Guthrie Clinic' and their address.
4. For section 3, select the types of information you wish to disclose by checking the appropriate boxes. You can also provide additional descriptions and dates as needed.
5. In section 4, enter the name and contact details of the individual or organization that will receive this information.
6. Indicate the purpose of disclosure in section 5 by checking one or more options provided.
7. Choose your preferred format for receiving this information in section 6 by selecting hardcopy, CD/DVD, or online.
8. Review sections 7 through 9 carefully to understand your rights regarding this authorization before signing at the bottom of the form.

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