University of Colorado Hospital Medical Record 2025

1. Click ‘Get Form’ to open the University of Colorado Hospital Medical Record in the editor.
2. Begin by entering the Patient Name(s) and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the Social Security Number, including only the last four digits, and provide a Contact Phone Number for any follow-up.
4. In the 'Authorization to Release and/or Obtain Patient Information' section, specify both the releasing facility and receiving entity by entering their names and addresses.
5. Indicate what information you wish to review by checking the appropriate boxes under 'Information to be Reviewed.'
6. Select which records you want photocopied and released by checking all applicable options in that section.
7. Complete the purpose for release by marking one or more reasons provided on the form.
8. Sign and date at the bottom of the form, ensuring that your printed name and relationship to the patient (if applicable) are included.

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