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GENEVA FAMILY PRACTICE 302 Randall Road * Suite 202 * Geneva, IL 60134 * (630) 2321818 * Fax (630) 2321868 www.genevafamilypractice.com * GAP×GFP1.authorization TO RELEASE MEDICAL RECORDS (INBOUND) Our
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How to fill out release medical records to

01
To fill out a release of medical records form, follow these steps:
02
Obtain the specific release of medical records form from the healthcare provider or facility that holds your medical records.
03
Provide your personal information, including your full name, date of birth, and contact information.
04
Specify the purpose of the release, such as transferring records to a new healthcare provider or for personal use.
05
Indicate the dates or timeframe for which you authorize the release of your medical records.
06
Include any specific details or instructions regarding the information to be released, such as specific healthcare providers or types of records.
07
Sign and date the form, ensuring it is completed accurately and legibly.
08
Review the form for any additional requirements or instructions provided by the healthcare provider.
09
Submit the completed form to the healthcare provider or facility as instructed, either in person, by mail, or through secure online portals.
10
Note: It's important to read and understand the form's terms and conditions before signing it. If you have any questions or concerns, seek clarification from the healthcare provider.

Who needs release medical records to?

01
Several individuals or entities may require the release of medical records, including:
02
- New healthcare providers: when you change doctors or specialists, they may need your previous medical records to provide appropriate care.
03
- Insurance companies: to process claims related to your healthcare or disability benefits, insurers may request access to your medical records.
04
- Legal representatives: if you are involved in a legal matter, such as a personal injury lawsuit or disability claim, your medical records may be required to support your case.
05
- Employers or government agencies: certain employers or government agencies may request medical records as part of the hiring process, workers' compensation claims, or disability accommodation requests.
06
- Personal use: individuals themselves may request a release of medical records for personal reasons, such as keeping personal health records or seeking a second opinion from another healthcare provider.
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