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STUDENT HEALTH SERVICES Division of Enrollment and Student Services THE UNIVERSITY OF TEXAS PAN AMERICAN 1201 West University Drive Edinburg, Texas 785412999 Office (956) 6652511 Fax (956) 6652512
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How to fill out medical release - UTPA:

01
Obtain the medical release form from the UTPA website or request it from the appropriate department.
02
Fill out the patient's personal information, including their full name, date of birth, address, and contact information.
03
Provide the healthcare provider's information, such as their name, address, and contact details.
04
Specify the purpose of the medical release, indicating if it is for a specific treatment or for ongoing medical care.
05
Enter the desired duration of the medical release, specifying if it is for a single visit or a specific period of time.
06
Include any special instructions or limitations, if applicable, regarding the healthcare provider's access to the patient's medical records.
07
Review the form for accuracy and completeness before signing and dating it.
08
If the patient is a minor, ensure that a parent or legal guardian also signs the medical release form.
09
Submit the completed and signed medical release form to the appropriate department or healthcare provider.

Who needs medical release - UTPA:

01
UTPA students who require medical treatment or care from off-campus healthcare providers.
02
UTPA student-athletes who need to grant permission for the release of their medical records to the university's sports medicine team.
03
UTPA employees who seek medical treatment from healthcare providers other than those affiliated with the university's employee health services.
04
Other individuals affiliated with UTPA, such as alumni or contractors, who need to authorize the release of their medical information to specific parties within the university.
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Medical release - UTPA is a form that allows the release of medical information to specified individuals or organizations.
The patient or legal guardian is required to file the medical release - UTPA.
To fill out the medical release - UTPA, the patient or legal guardian must provide their personal information, specify the individuals or organizations authorized to receive medical information, and sign and date the form.
The purpose of medical release - UTPA is to ensure that medical information is only shared with authorized individuals or organizations for the benefit of the patient.
The medical release - UTPA must include the patient's personal information, the individuals or organizations authorized to receive medical information, and a signature from the patient or legal guardian.
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