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AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION BOUDOIR COLLEGE HEALTH SERVICES 3600 College Station, Brunswick, ME 04011 Telephone: 207.725.3770 Fax: 207.725.3905 I, authorize employees and agents,
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How to fill out records release form 1-29-18

01
To fill out the records release form 1-29-18, follow these steps:
02
Begin by providing your personal information, such as your full name, date of birth, and contact information.
03
Indicate the healthcare provider or facility from where you are requesting the records. This may include the name of the hospital, clinic, or physician.
04
Specify the exact records you are seeking to release. Be as specific as possible, including the dates of service or the types of records you need.
05
Indicate the purpose of the release. Some common reasons include personal use, continuity of care, legal matters, or insurance claims.
06
Specify the individual or entity to whom the records should be released. This could be yourself, another healthcare provider, an attorney, or any other authorized recipient.
07
Sign and date the records release form. Ensure that all the information provided is accurate and complete.
08
Submit the form to the appropriate healthcare provider or facility as instructed. This may involve mailing, faxing, or delivering the form in person.
09
Keep a copy of the completed form for your records. It is recommended to retain proof of submission, such as a delivery receipt or confirmation.
10
Follow up with the recipient to ensure that the records release has been processed and received.

Who needs records release form 1-29-18?

01
Anyone who requires access to their medical records from the specified date, which is January 29, 2018, would need the records release form 1-29-18. This could include patients who want to transfer their records to a new healthcare provider, individuals involved in legal matters that require access to medical information, or individuals seeking insurance claims related to the specified date. The form is necessary to authorize the release of medical records to the designated recipient.
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Records release form 1-29-18 is a document used to authorize the release of records or information.
Anyone who needs to request the release of records or information is required to file records release form 1-29-18.
To fill out records release form 1-29-18, provide your personal information, specify the records or information you are requesting, and sign the form.
The purpose of records release form 1-29-18 is to authorize the release of records or information to the requesting party.
The information reported on records release form 1-29-18 includes personal details, the specific records being requested, and the purpose of the request.
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