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THE SPINE AND SPORTS CENTER BENNY, M.D. CHERYL BENNY, M.D. MARY VU ONG, PAC Galleria 2100 West Loop South #150 Houston, Texas 77027
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01
Begin by gathering all the necessary information you will need to complete the form. This may include your personal information such as your name, address, and contact details, as well as any specific details related to the records you want to release.
02
Read the instructions carefully to ensure you understand what is required of you. Pay attention to any specific formatting or additional documents that may be needed.
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Start filling out the form by entering your personal information in the designated fields. Make sure to double-check for any spelling or typographical errors.
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Provide details about the records you wish to release. This may include the type of records, the date range, and any specific details that will help the recipient locate the records.
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If the records release form requires authorization, ensure that you sign and date the form in the designated area to give your consent for the release of the records.
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Review the completed form to make sure all the information is accurate and complete. Take the time to double-check all the details before submitting the form.
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Make copies of the completed form for your records before submitting it to the appropriate recipient.

Who needs records release - form:

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Individuals who are seeking to access their own personal records from a healthcare provider, educational institution, or any other organization that maintains confidential records.
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Insurance companies or government agencies that need access to an individual's records for processing claims or determining eligibility.
Remember to always consult the specific guidelines and requirements provided by the organization or institution from which you are requesting records, as they may have additional instructions or forms to be completed.
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