How to use or fill out chkd medical records with our platform
- Click ‘Get Form’ to open the chkd medical records in the editor.
- Begin by filling in the 'Request Records From' section with the name and address of the entity you are requesting records from.
- Next, complete the 'Forward Records To' section with the name and address where you want the records sent.
- In the 'TO DISCLOSE THE FOLLOWING INFORMATION' field, specify any pertinent medical records and immunizations. If there are additional details, include them in the provided space.
- Fill in the patient’s name and date of birth accurately to ensure proper identification.
- State the purpose of disclosure clearly in the designated area to explain why you need these records.
- Finally, sign as either the patient or legal guardian, indicating your relationship to the patient and date of signing.
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