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Medical Record Authorization Iowa Orthopedic Center 450 Laurel Street, Suite A Des Moines, Iowa 50314 Phone: 15152478400 Fax: 15153627918 Patient Name Maiden Name SS# Date of Birth Home Phone Cell/Work
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What is medical record authorization?
Medical record authorization is a legal document that gives healthcare providers permission to release a patient's medical information to specified individuals or organizations.
Who is required to file medical record authorization?
Patients or their legal guardians are required to file a medical record authorization form.
How to fill out medical record authorization?
To fill out a medical record authorization form, one must provide their personal information, specify who is authorized to access their medical records, and sign and date the form.
What is the purpose of medical record authorization?
The purpose of medical record authorization is to protect a patient's privacy and ensure that their medical information is only shared with authorized individuals or organizations.
What information must be reported on medical record authorization?
Medical record authorization forms typically require the patient's name, date of birth, contact information, the purpose of the disclosure, and the duration of the authorization.
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