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OCD Clinics New Braunfels Carrollton The Woodlands Main Office: 262 N Union, New Braunfels, TX 78130 Phone: 8305158480 Fax: 8773105968AUTHORIZATION TO RELEASE HEALTHCARE INFORMATIONPatients Name:Date
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01
Open the ocd-clinics-release-of-information-3-20-17docx document on your computer.
02
Read through the document carefully to understand what information is being requested.
03
Start by filling out your personal information, including your full name, address, phone number, and date of birth.
04
Next, provide the name of the clinic or healthcare provider to whom you are authorizing the release of information.
05
Specify the type of information you are authorizing to be released. This could include your medical records, lab results, treatment plans, or any other relevant documents.
06
Indicate the purpose of the release of information, such as for continuity of care, legal proceedings, or research purposes.
07
Consider any additional instructions or limitations you want to include in the release of information. For example, you may choose to specify a time period for which the authorization is valid or any specific records or information that should not be released.
08
Review the completed form for accuracy and completeness.
09
Print the form if necessary, or save a copy for your records.
10
Sign and date the form to provide your consent for the release of information.
11
If required, you can also ask a witness to sign the form.
12
Submit the completed form to the appropriate clinic or healthcare provider as instructed.

Who needs ocd-clinics-release-of-information-3-20-17docx?

01
Any individual who wants to authorize the release of their medical information from OCD clinics or healthcare providers may need to fill out the ocd-clinics-release-of-information-3-20-17docx form.
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ocd-clinics-release-of-information-3-20-17docx is a document used for releasing information related to the operations of OCD clinics, likely pertaining to patient data or clinic practices.
Entities operating OCD clinics or individuals handling patient data in those clinics are required to file this document.
To fill out ocd-clinics-release-of-information-3-20-17docx, individuals should provide relevant details related to the release of information, including patient consent and specifics about the information being released.
The purpose of ocd-clinics-release-of-information-3-20-17docx is to authorize the release of confidential information from OCD clinics while ensuring compliance with privacy regulations.
The document must report patient identifiers, type of information being released, purpose of release, and any conditions of the release.
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