Arrowhead regional medical center medical records 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Information, including your Name, SSN, Medical Record Number, and Date of Birth (DOB). Ensure all details are accurate for proper identification.
3. In the authorization section, specify whether you authorize Arrowhead Regional Medical Center or Family Health Center to disclose your health information. Check the appropriate box for obtaining or disclosing information.
4. Fill in the recipient's details, including Name, Position Title & Company (if applicable), and Mailing Address. This ensures that your information is sent to the correct location.
5. Select the specific information you wish to disclose by checking all applicable boxes under 'Information to be Disclosed'. Be mindful of sensitive categories like Psychotherapy Notes.
6. Indicate the dates of care included in this authorization. This helps narrow down the records being requested.
7. Review the understanding statements regarding your rights and the implications of this authorization before signing.
8. Finally, sign and date the form at the bottom. If a representative is signing on your behalf, include their authority or relationship.

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