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FOR INTERNAL USE ONLY: MR# Pick Up Date: Records have been mailed/Picked up Records have been faxed. FAX#: Records have not been sent. Reason: Initials: Date: AUTHORIZATION TO RELEASE PROTECTED HEALTH
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Records that have been mailed or picked up.
Individuals or entities who have sent or received records through mail or pick up.
Fill out the required fields with accurate information regarding the records that have been mailed or picked up.
To keep track of records that have been sent or received through mail or pick up for documentation and reference purposes.
Details of the sender and recipient, contents of the records, date of mailing or pick up, and any relevant tracking information.
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