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OREGON UROLOGY INSTITUTE 2400 Hartman Lane Springfield, OR 97477 Phone: 5413343350 Fax: 5417464569 Authorization to Use and Disclose Health Information Last Middle: First: Date of Birth: SSN: I Authorize

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1. Start by gathering all necessary information, such as your personal details, medical history, and insurance information.
2. Visit the Oregon Urology Eugene website or contact their office to obtain the specific form for filling out.
3. Begin filling out the form by entering your personal information, including your name, date of birth, address, and contact information.
4. Provide your medical history, including any previous surgeries, medications you are currently taking, and any known allergies.
5. If applicable, include your insurance information, including your policy number and any required authorization or referral numbers.
6. Be sure to read and understand each section of the form before providing your answers. If you have any questions or need further clarification, don't hesitate to reach out to the Oregon Urology Eugene office for assistance.
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10. If you have any further questions or need to make any changes to the form after submission, contact Oregon Urology Eugene as soon as possible.

Who needs Oregon Urology Eugene:

1. Individuals suffering from urological conditions such as kidney stones, urinary tract infections, prostate issues, or bladder problems may need Oregon Urology Eugene services.
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What is oregon urology eugene?

Oregon Urology Eugene is a medical facility specializing in urology services located in Eugene, Oregon.

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Oregon Urology Eugene is required to be filed by the medical professionals and staff working at the facility.

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Oregon Urology Eugene can be filled out by providing all relevant medical information and details about the services offered at the facility.

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The purpose of Oregon Urology Eugene is to maintain accurate records and compliance with medical regulations.

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Information such as patient data, medical procedures, treatments, and any relevant medical information must be reported on Oregon Urology Eugene.

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