Dupage medical group medical records 2025

1. Click ‘Get Form’ to open the DuPage Medical Group medical records authorization form in the editor.
2. Begin by filling out the Patient Information section. Enter your name, date of birth, address, telephone number, and city/state/ZIP code.
3. In the next section, specify the individual or organization to whom you authorize the release of your records. Fill in their name and address details.
4. Select your preferred method of delivery by checking the appropriate box. If choosing electronic delivery, provide an email address and select a PIN number.
5. Indicate where you would like to pick up your records if applicable. Provide the name of the person picking up the records if it is not you.
6. Choose the purpose for disclosure from the provided options and check all relevant boxes for specific information requested.
7. Review and sign at the bottom of the form, ensuring all necessary signatures are included before submitting.

Start using our platform today to easily complete your DuPage Medical Group medical records form online for free!