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PATIENT AUTHORIZATION TO DISCLOSE HEALTH INFORMATION Patient Name: Date of Birth: Previous Names (please list): I authorize Columbia River Women's Center to do the following: Provide Information Receive
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How to fill out previous names please list

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To fill out the "previous names" section, please follow the steps below:

01
Start by providing your current legal name. This is the name you currently use and identify with.
02
Next, provide any previous names that you have used in the past. This could include your maiden name, previous married names, or any other names you have legally changed from.
03
If you have had multiple previous names, list them in chronological order. This means starting with the earliest name and moving towards the most recent.
04
Be sure to include all relevant information for each previous name, such as your birth name, the reason for the name change, and any documentation you have to support the name change (such as marriage certificates or court orders).

Who needs the "previous names please list" information?

01
When completing official forms or applications, such as for a job, passport, or legal documents, you may be asked to provide your previous names. The purpose of this is to establish your identity and ensure there is a clear record of your name history.
02
Some government agencies, such as the Social Security Administration or Department of Motor Vehicles, may require this information to update your records or issue new identification documents.
03
It's also important to provide your previous names if you are involved in any legal proceedings, such as a divorce or name change petition, as it helps maintain an accurate legal record.
Remember, it's important to be truthful and complete when providing your previous names. Failing to disclose this information when required can lead to complications and potential legal issues.
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Previous names refer to any name or names that an individual or entity used before their current name.
Individuals or entities who have legally changed their name or used different names in the past are required to file previous names.
To fill out previous names, individuals or entities can list all the names they have used before their current name on the appropriate forms or documents.
The purpose of listing previous names is to provide a complete and accurate record of an individual or entity's name history.
The information that must be reported on previous names includes the full name or names that were used in the past and any relevant dates or reasons for the name change.
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