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Division of Clinical Genetics CHILDREN HOSPITAL OF NEW YORK 3959 Broadway BH7N726B, New York, NY 10032 (212) 3424622 (212) 3059058 FAX AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION/MEDICAL RECORDS
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Fill out your personal information in the designated fields, including your name, address, contact information, and any other required details.
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Follow the prompts and sections within the form to input specific medical record information, such as the date of the medical visit, the healthcare provider's name, and a description of the medical care received.
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Individuals who wish to access and obtain their own medical records.
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Discover Medical Records Release form is a document that authorizes the release of an individual's medical records to a specified party.
The individual whose medical records are being released is required to fill out and file the Discover Medical Records Release form.
The form usually requires the individual's personal information, details of the medical records being released, and authorization signature.
The purpose of the form is to authorize the release of medical records to a specified party, such as a healthcare provider or insurance company.
The form typically requires details such as the individual's name, date of birth, medical record number, and the specific records to be released.
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