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Four Seasons Pediatrics 532 Moe Road Clifton Park, NY 12065 pH 5183832425 Fax 5183833255 Authorization for Release of Health Information (Medical records being sent TO our office) Name of Facility
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Start by gathering all relevant medical documents, such as test results, doctor's notes, and prescriptions.
02
Ensure that the medical records are organized and labeled correctly for easy identification.
03
Fill in the required personal information accurately, including full name, date of birth, address, and contact details.
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Enter the details of the medical condition being treated, including the diagnosis and treatment plan.
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Provide a comprehensive medical history, including any previous illnesses, surgeries, or allergies.
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Include a list of current medications being taken, along with the dosage and frequency.
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If applicable, attach any supporting documents, such as x-ray or MRI scans related to the medical condition.
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Review the filled-out medical records to ensure all information is correct and complete.
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Follow the instructions provided by the recipient (e.g., healthcare provider or insurance company) for sending the medical records.
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Securely package the medical records and send them using a reliable and trackable delivery method.

Who needs medical records being sent?

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Medical records being sent are typically needed by healthcare providers, specialists, hospitals, clinics, insurance companies, and legal entities involved in a medical case or claim.
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Medical records being sent refer to the documentation of a patient's medical history, treatments, and health information that is being transferred or shared with a different healthcare provider.
Healthcare providers, hospitals, clinics, and other medical facilities are required to file medical records being sent.
Medical records being sent can be filled out by documenting all relevant information about the patient's health condition, treatments, medications, and any other medical interventions.
The purpose of medical records being sent is to ensure continuity of care for the patient and allow healthcare providers to have access to the patient's complete medical history.
Medical records being sent must include the patient's personal information, medical history, current health condition, treatments received, medications prescribed, and any relevant test results.
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