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Medical Records Release Form Bloomsburg University Student Health Center (570) 3894451 (P) (570) 3893417 (F) Room 324 Kerr Union Building 400 E. Second Street Bloomsburg, PA 17815 I understand that

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What is medical records release authorization?

Medical records release authorization is a form that allows healthcare providers to release a patient's medical information to a third party.

Who is required to file medical records release authorization?

Any individual who wants their medical records to be released to a third party is required to file a medical records release authorization.

How to fill out medical records release authorization?

To fill out a medical records release authorization, one must provide personal information, specify the medical information to be released, and sign the form.

What is the purpose of medical records release authorization?

The purpose of medical records release authorization is to ensure that a patient's medical information is kept confidential and only released to authorized individuals or organizations.

What information must be reported on medical records release authorization?

Medical records release authorization must include the patient's name, date of birth, medical record number, specific information to be released, and the recipient's information.

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