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14030 NE 24th Street, #104 Bellevue, WA 98007 3609618766 tel 4256439210 fax Anne drained. Authorization for Disclosure of Healthcare InformationClient Name: Birth date: / / SS #: Previous Name(s):

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How to fill out eastside dermatology records release

01

To fill out Eastside Dermatology Records Release, follow these steps:

02

Start by obtaining the Eastside Dermatology Records Release form. You can usually find it on their website or request a copy from their office.

03

Read the instructions on the form carefully to understand what information is required and how to properly fill it out.

04

Begin by providing your personal information, such as your full name, date of birth, and contact details. Ensure that you enter this information accurately and legibly.

05

Next, indicate the purpose for which you are requesting your records to be released. This could be for personal use, to transfer to a new healthcare provider, or for legal purposes. Specify the details clearly.

06

If you are authorizing the release of your records to a specific individual or organization, provide their name, contact information, and any additional details required.

07

Review the form once again to ensure you have completed all the necessary sections. Make sure your signature, date, and any other required fields are filled in correctly.

08

Keep a copy of the completed form for your records, and then submit the original form to Eastside Dermatology by mail, fax, or in person. Follow their specific instructions for submission.

09

If you have any questions or need assistance, don't hesitate to contact Eastside Dermatology directly.

10

By following these steps, you will successfully fill out the Eastside Dermatology Records Release form.

Who needs eastside dermatology records release?

01

Anyone who wishes to obtain their medical records from Eastside Dermatology needs to fill out the Eastside Dermatology Records Release form.

02

This includes patients who are transferring to a new healthcare provider, individuals who require their records for personal use, or those who need the records for legal purposes.

03

The form ensures that the release of medical records is done lawfully and with the consent of the patient or the patient's authorized representative.

04

Therefore, anyone who falls into these categories of needing access to their medical records from Eastside Dermatology should complete the Records Release form.

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