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Mary Regional Health* Authorization to Release Protected Health InformationPatient Name: Birth Date: Last 4 digits of S.S. # Address: Phone # I request and authorize: To Release my health information
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To fill out the Maury Regional Health form, follow these steps:
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Start by visiting the Maury Regional Health website.
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Maury Regional Health is a not-for-profit regional health system serving southern Middle Tennessee.
All individuals or entities providing healthcare services in the Maury Regional Health system are required to file.
Maury Regional Health can be filled out online or by submitting physical forms to the appropriate department.
The purpose of Maury Regional Health is to collect data on healthcare services provided within the system for reporting and analysis.
Information such as patient demographics, diagnoses, treatments, procedures, and outcomes must be reported on Maury Regional Health.
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