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2014-2016 Medical Release Form First United Methodist Church New Braunfels S T U D E N T M I N I S T R Y This two-year release form is valid from date of signature through December 31, 2015, Youth
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How to fill out 2014-2016 medical release form
How to fill out 2014-2016 medical release form:
01
Start by carefully reading through the form to understand its purpose and the information it requires.
02
Fill in your personal information accurately, including your full name, date of birth, address, and contact information.
03
Provide details about your healthcare provider, such as their name, address, and phone number.
04
Indicate the timeframe for which you are authorizing the release of your medical records (in this case, 2014-2016).
05
Specify the types of medical records you are authorizing the release of, whether it's general medical history, specific treatments, lab results, or any other relevant information.
06
Sign and date the form to validate your authorization.
07
If required, provide any additional documentation requested by the form, such as proof of identification or insurance information.
08
Keep a copy of the completed form for your records.
Who needs 2014-2016 medical release form:
01
Patients who are seeking medical care from a new healthcare provider and wish to transfer their medical records from a previous doctor.
02
Individuals who are participating in clinical research and need to grant permission for the release of their medical records for study purposes.
03
Individuals who have changed medical insurance providers and need to authorize the release of past medical records to the new insurer.
It's important to note that the specific requirements for the 2014-2016 medical release form may vary depending on the healthcare provider or institution requesting it. Therefore, it is always advisable to carefully review and follow the instructions provided with the form.
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