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AuthorizationforReleaseofMedicalRecordstotheDukeStudentHealthCenter PatientName: DateofBirth: MedicalRecordNumber: Iauthorizeandrequestthat: (Person/Physician/Entity to release records) r MailtotheDukeStudentHealthCenter,DUMCBox2899,Durham,NC27710.
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How to fill out release medical records form:

01
Start by filling in your personal information including your name, date of birth, and contact details.
02
Provide the name of the healthcare provider or facility from which you want to obtain your medical records.
03
Specify the type of medical records you are requesting, such as laboratory reports, diagnostic imaging results, or treatment summaries.
04
Indicate the date range for the records you are requesting. This could be a specific time frame or a start and end date.
05
If you have any specific requirements or instructions regarding the release of your medical records, include them in the designated section.
06
Sign and date the form to certify that you are authorizing the release of your medical records.
07
Keep a copy of the completed form for your records.

Who needs release medical records form:

01
Individuals who are switching healthcare providers and want to transfer their medical records to the new provider.
02
Patients who are participating in a research study or seeking a second opinion and need to share their medical records.
03
Individuals who are applying for disability benefits or insurance claims and require their medical records as supporting documentation.
04
Caregivers or legal representatives who are authorized to access the medical records of a patient.
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Release medical records is to provide access to a patient's medical information to authorized individuals or entities.
Healthcare providers or facilities are required to release medical records to authorized individuals or entities upon request.
To fill out a release medical records form, the patient or authorized representative must provide basic information such as their name, date of birth, and the specific records requested.
The purpose of releasing medical records is to ensure that individuals have access to their medical history for medical treatment or legal purposes.
Release medical records must include the patient's medical history, diagnosis, treatment plans, medication, and any other relevant information.
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