Penn medicine medical release form 2025

1. Click ‘Get Form’ to open the penn medicine medical release form in the editor.
2. Begin by filling in your personal details, including your name, date of birth, and contact information. Ensure accuracy as this information is crucial for identification.
3. In the 'Disclosed Information' section, check all relevant items you wish to be released. Options include entire records, lab reports, and more. Be thorough to ensure all necessary information is included.
4. Specify the period of care by listing applicable treatment dates. This helps clarify which records are being requested.
5. Indicate any special records that may require additional consent, such as AIDS/HIV or psychiatric care. Make sure to check the appropriate boxes.
6. Fill in the location of services where you received care and provide details about who will receive this information.
7. Finally, sign and date the authorization section. If someone else is signing on your behalf, include their relationship to you and reason for signing.

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