To download release of information form - Brookwood Medical Center 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, including last, first, and middle names. Ensure accuracy as this information is crucial for identification.
3. Fill in the patient's Social Security Number (SSN) in the designated format: ___-__-_.
4. Provide the home address and telephone number of the patient to facilitate communication.
5. Enter the date of birth to confirm the identity of the patient.
6. Specify which information is to be disclosed by checking relevant boxes related to highly confidential information, such as mental health or HIV/AIDS-related testing.
7. Identify the recipient by providing their name and address where the health information should be sent.
8. Indicate how long this authorization will remain effective by selecting an option from the provided choices.
9. State the specific purpose for which Brookwood Medical Center may use or disclose health information.
10. Finally, sign and date the form. If applicable, include signatures from authorized representatives for minors or those unable to sign themselves.

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