325 949 pdf 2026

1. Click ‘Get Form’ to open the 325 949 pdf in the editor.
2. Begin by entering the patient's name, date of birth, and social security number in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the address and phone number of the patient. This helps maintain clear communication regarding their medical records.
4. In the authorization section, indicate whether you authorize River Crest Hospital to provide or request information by checking the appropriate boxes.
5. Specify the facility or individual from whom information will be requested, including their address and contact details.
6. Select which types of information you wish to release by checking the relevant boxes, such as discharge summaries or psychiatric evaluations.
7. Sign and date the form at the bottom. If applicable, a parent or legal guardian must also sign if the patient is aged 16 or 17.

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