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AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION Print patients legal name: Date of Birth: / / Address: Street Address City State Zip Code Phone Number: Alternate Phone number: Please release
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How to fill out obstetric medical record release

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How to fill out obstetric medical record release

01
Obtain a copy of the obstetric medical record release form from your healthcare provider or hospital.
02
Read through the form carefully to understand the information being requested.
03
Fill out the patient information section, including your full name, date of birth, and contact information.
04
Provide the name and contact information of the healthcare provider or hospital that you wish to release your medical records to.
05
Specify the dates or timeframe of the records you want to be released.
06
Sign and date the form to confirm your request.
07
Make a copy of the completed form for your records.
08
Submit the form to your healthcare provider or hospital as per their instructions.

Who needs obstetric medical record release?

01
Anyone who wishes to have their obstetric medical records released to another healthcare provider or hospital needs an obstetric medical record release form.
02
This may include individuals who are changing healthcare providers, seeking a second opinion, or transferring care to a different hospital.
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Obstetric medical record release is the process of allowing the release of medical records related to pregnancy, childbirth, and postpartum care.
Obstetric medical record release is typically filed by the healthcare provider or facility where the patient received prenatal and postnatal care.
To fill out an obstetric medical record release, the patient or authorized representative must complete a release form provided by the healthcare provider or facility.
The purpose of obstetric medical record release is to allow the transfer of medical information between healthcare providers for continuity of care.
Obstetric medical record release must include the patient's personal information, dates of prenatal appointments, details of labor and delivery, postpartum care, and any relevant medical history.
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