Get the free Authorization to Release Patient Information - WorkConnections - workconnections umich
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Argus II Building 400 South Fourth Street Ann Arbor, MI 48103-4816 Phone: Toll-free: Fax: E-mail: Website: For Office Use Only Information: I D Verified: (734) 615-0643 (877) 869-5266 (734) 936-1913
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What is authorization to release patient?
Authorization to release patient is a document that gives permission to a healthcare provider to share the patient's medical information with another individual or organization.
Who is required to file authorization to release patient?
The patient or their legal guardian is usually required to file an authorization to release patient.
How to fill out authorization to release patient?
To fill out an authorization to release patient, you need to provide the patient's personal information, specify the information to be released, the recipient of the information, and sign the form.
What is the purpose of authorization to release patient?
The purpose of authorization to release patient is to ensure the confidentiality of the patient's medical information while allowing authorized individuals or organizations to access it for specific purposes.
What information must be reported on authorization to release patient?
The authorization form should include the patient's full name, date of birth, contact information, the specific information to be released, the purpose of the release, and the name of the recipient.
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