Memorial hermann discharge papers 2025

1. Click ‘Get Form’ to open the memorial hermann discharge papers in the editor.
2. Begin by entering your personal information, including your name, date of birth, address, medical records number, and telephone number in the designated fields.
3. Select the facilities from which you authorize the release of your records by checking the appropriate boxes under 'HOSPITALS' and 'OUTPATIENT CENTERS'.
4. In the 'RELEASE TO' section, provide the name and address of the person or organization to whom your records will be sent. Include their phone number and fax number if applicable.
5. Specify the dates of service for which you are requesting records. This line must be completed for processing.
6. Indicate the purpose for which you are requesting this information by checking one of the options provided.
7. Choose whether you want your medical records copied to paper or electronic format by selecting one of those options.
8. Select specific portions of your protected health information that you wish to be released by checking relevant boxes.
9. Finally, sign and date the authorization at the bottom of the form, ensuring all required fields are completed before submission.

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