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North Fulton Eye Center, PC Cumming Eye Clinic Susanne M. Hewitt, MD Richard E. Par, MD Marathi Rapid, MD AUTHORIZATION FOR USE/RELEASE OF MEDICAL INFORMATION Step 1: Patient Information Name: (Print)
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How to fill out authorization for userelease of
How to fill out authorization for userelease of
01
Read the authorization form carefully to understand the requirements.
02
Provide accurate information about the user for whom the release is being authorized.
03
Fill out the user's personal details such as name, date of birth, address, etc.
04
Specify the purpose of the release and the duration of authorization if applicable.
05
Include any additional information or special requests in the designated section.
06
Sign and date the authorization form.
07
Submit the completed form to the appropriate authority for processing.
Who needs authorization for userelease of?
01
Individuals who are legally authorized to act on behalf of the user.
02
Parents or legal guardians of minor users.
03
Medical professionals requiring access to user's medical records.
04
Educational institutions requesting user's academic records.
05
Employers requesting user's employment history.
06
Law enforcement agencies or attorneys requiring user's information for legal purposes.
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