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AUTHORIZATION FOR RELEASE OF INFORMATION
This authorization for release of protected health information is provided by OrthoSouth. Please see the Patient Notice for
information regarding how your
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What is this authorization for release?
This authorization for release allows the release of certain information to specified parties.
Who is required to file this authorization for release?
Individuals or entities seeking to release specific information are required to file this authorization.
How to fill out this authorization for release?
The authorization form must be completed with accurate and detailed information as requested.
What is the purpose of this authorization for release?
The purpose of this authorization is to grant permission to release information to designated recipients.
What information must be reported on this authorization for release?
The authorization must include details about the information being released and the parties involved.
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