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VETERINARY MEDICAL RECORDS RELEASE FORM Client Date Phone Address Email City/State/Zip I the undersigned do hereby grant my permission for the release of any or all the information contained in the medical record of the pet listed to be given upon request to Del Mar Veterinary Hospital Pet Name s For Release of Medical Records This release will remain in effect until you notify us in WRITING of any desired changes Client Signature Del Mar Veterinary Hospital 1023 A1A Beach Blvd.
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How to fill out veterinary medical records release

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How to fill out veterinary medical records release

01
Start by gathering all relevant information about the patient and the veterinary medical records.
02
Include the patient's name, address, contact details, and any identification numbers if applicable.
03
Specify the reason for requesting the medical records release, such as transferring to a new veterinarian or seeking a second opinion.
04
Clearly state the dates or time period for which the records are being requested.
05
Include a statement acknowledging that the owner/authorized person has the right to request and receive the medical records.
06
If necessary, provide any additional documentation or forms required by the veterinary clinic or hospital.
07
Submit the completed records release form to the appropriate veterinary clinic or hospital.
08
Follow up with the clinic or hospital to ensure the records are received and processed.
09
Maintain a copy of the filled-out veterinary medical records release for your records.

Who needs veterinary medical records release?

01
Pet owners who are transferring their pets' care to a new veterinarian.
02
Pet owners who are seeking a second opinion from a different veterinary clinic or hospital.
03
Pet owners who are moving to a different city or state and need to provide medical records to a new veterinarian.
04
Pet owners who are participating in research studies or specialized treatments that require the sharing of medical records.
05
Veterinarians who need access to a patient's previous medical records in order to provide proper care and treatment.
06
Animal shelters or rescue organizations that receive animals and need access to their medical records for evaluation and treatment purposes.
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Veterinary medical records release is a form that allows a veterinary clinic to release a patient's medical records to another party, such as a new veterinarian or owner.
The owner of the animal or their authorized representative is required to file the veterinary medical records release.
To fill out a veterinary medical records release, the owner or authorized representative must provide their contact information, the name of the animal, and specify who the records should be released to.
The purpose of veterinary medical records release is to ensure that a patient's medical history and treatment information can be transferred to a new caregiver for continuity of care.
The veterinary medical records release form must include the patient's name, owner's contact information, details of the records being released, and the recipient's information.
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delmarvethospital a1a undersigned blvd fl augustine tel veterinary

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