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INTERNAL MEDICINE at the CROSSINGSRelease of Medical Records Sending Records Patient Information: Name: Date of Birth: Mailing Address: City: State: ZIP: Last 4 digits of S.S. #: Phone Number(s):

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What is release of medical records?

It is a document that allows a patient to authorize healthcare providers to disclose their medical information to others.

Who is required to file release of medical records?

Any individual who wants their medical information to be shared with other healthcare providers or third parties.

How to fill out release of medical records?

The patient needs to complete the release form by providing their personal information, the recipient of the records, and the duration of the authorization.

What is the purpose of release of medical records?

The purpose is to ensure that the patient's medical information is shared only with authorized individuals or entities for proper healthcare purposes.

What information must be reported on release of medical records?

The patient's personal information, the recipient's information, the duration of the authorization, and specific details about the medical records being disclosed.

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