Myaurora chart 2025

1. Click ‘Get Form’ to open the myaurora chart in the editor.
2. Begin by filling out the 'PATIENT INFORMATION' section. Enter your name, address, city, state, zip code, date of birth, and daytime phone number.
3. In the 'AUTHORIZES' section, provide the name and address of the health care provider or plan you are authorizing.
4. Specify who you are disclosing information to in the 'TO DISCLOSE TO' section. Choose delivery options such as pick up, view on site, or mail.
5. Indicate the dates of information to be disclosed. If left blank, only records from the past two years will be shared.
6. Detail what information you want disclosed in the 'INFORMATION TO BE DISCLOSED' section. Be specific about medical and billing records.
7. Check any information you do not want disclosed under 'I DO NOT WANT THE FOLLOWING INFORMATION DISCLOSED.'
8. Fill in the expiration date for this authorization. If left blank, it will expire one year from the date signed.
9. Select the purpose for disclosure by checking all that apply in the 'PURPOSE' section.
10. Finally, sign and date at the bottom of the form. If someone else is signing on your behalf, complete additional required fields.

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