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RELEASE OF MEDICAL RECORDS Bryan Mar Medical Specialists, Assoc. 825 Old Lancaster Road, Suite 320 Bryan Mar, PA 19010 (610) 5273800 ext 3027 Cardiology Offices 820 Old Lancaster Rd., Suite 400 3855
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How to fill out release of medical recordsdocx:
01
Start by downloading the release of medical recordsdocx form from a reputable source or obtaining it directly from your healthcare provider.
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Read through the instructions carefully to understand the purpose and requirements of the form.
03
Begin filling out the form by providing your personal information, including your full name, date of birth, and contact details.
04
Enter the name and contact information of the healthcare provider or facility that will be releasing your medical records.
05
Specify the purpose for which you are requesting the release of medical records, such as for personal use, legal proceedings, or to transfer to another healthcare provider.
06
Indicate the timeframe or specific dates for which you want the medical records to be released.
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Check if you would like to include all relevant medical records or if you only need specific documents or information.
08
Provide your signature, indicating that you authorize the release of your medical records.
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Include the date of signing the form.
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Finally, submit the completed form to the healthcare provider or facility either in person, by mail, or through any other method specified in the instructions.
Who needs the release of medical recordsdocx:
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Patients who want to obtain a copy of their medical records for personal records or to provide them to another healthcare provider.
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Individuals who are involved in legal proceedings and require access to their medical records as evidence or for legal representation.
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Patients who are transferring their care to a new healthcare provider and need to share their medical history and records for continuity of care.
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