Orthopedic associates patient release form: Fill out & sign online

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Click ‘Get Form’ to open the orthopedic associates patient release form in the editor.
Begin by entering your personal information in the designated fields, including your name, date of birth, and contact details. Ensure accuracy as this information is crucial for processing.
In the authorization section, specify the healthcare facility authorized to disclose your medical records. This should be pre-filled with 'Orthopedic Associates of Dutchess County, PC'.
Indicate the dates and types of information you wish to disclose. Typically, this will include all necessary information for processing disability claims.
Complete the section regarding who will receive your records by filling in their name and address. Choose whether you prefer records mailed or faxed.
Review the restrictions and understand your rights regarding revocation of this authorization before signing at the bottom of the form.

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