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Lee's Summit Physicians Group Medical Record Release Authorization 1425 NW Blue Parkway Lee's Summit, MO 64086 Blue Springs Pediatrics Rain tree Pediatrics TH 1600 NW South Outer Road Phone: 8165243223
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How to fill out medical record release authorization
How to fill out medical record release authorization:
01
Obtain the necessary form: Contact the medical facility or healthcare provider where your records are held and request a medical record release authorization form. They may provide it electronically or in paper form.
02
Fill in your personal information: Start by providing your full name, date of birth, and contact information. Make sure to double-check the accuracy of your details to avoid any discrepancies.
03
Specify the purpose: Indicate why you are requesting the release of your medical records. Whether it is for personal reference, legal purposes, or transferring to another healthcare provider, clearly state the purpose to help facilitate the process.
04
Input relevant dates: Include the specific dates or time range for which you are authorizing the release of your medical records. This can be a specific appointment or a general timeframe, such as the past two years.
05
Identify the recipient: Indicate the name and contact information of the individual or organization to whom your medical records should be released. This could be your new healthcare provider, a lawyer, or yourself.
06
Specify the information to be released: Determine whether you want to release your entire medical record or only specific portions. If specific portions, clearly state which files, test results, or treatments you would like to include in the release.
07
Review and sign: Carefully read through the form, ensuring all the information you provided is accurate and complete. Sign the authorization form to signify your consent for the release of your medical records.
Who needs medical record release authorization:
01
Patients seeking second opinions: If you are seeking a second opinion or transferring to a different healthcare provider, a medical record release authorization is often required. This enables the new provider to access your previous medical records and provide you with appropriate care.
02
Individuals involved in legal proceedings: Legal cases often involve the need for medical records as evidence. Lawyers and individuals involved in legal proceedings may need medical record release authorization to gather necessary documents to support their case.
03
Insurance claims: When filing insurance claims, the insurance company may require access to your medical records to validate your claim and determine the appropriate coverage. In such cases, a medical record release authorization may be necessary.
04
Personal reference or medical history: Some individuals may require their medical records for personal reference or to keep a comprehensive medical history. This can be helpful in tracking past treatments, diagnoses, and medications, ensuring accurate and comprehensive healthcare.
Regardless of the reason, anyone who wishes to obtain their own medical records should request a medical record release authorization to comply with legal and privacy requirements.
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