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1005 Clifton Avenue, Clifton, NJ 07013 P (973) 4724114 F (973) 4724114MEDICAL RECORDS RELEASE FORM To: Address: Phone: Fax: Please release my medical records to: Physician Name: Mailing Address: Phone
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How to fill out rea medical records release

01
Start by obtaining a medical records release form from the healthcare provider or facility that has the records you wish to obtain.
02
Fill out the basic identifying information section, including your full name, date of birth, and contact information.
03
Specify the healthcare provider or facility from which you are requesting the records. Provide their name, address, and contact information.
04
Clearly state the purpose for requesting the medical records. Include any relevant dates or specific information regarding the records you need.
05
Sign and date the form, indicating your consent for the release of your medical records.
06
Make a copy of the completed form for your own records.
07
Submit the form to the healthcare provider or facility according to their preferred method (mail, fax, email, in-person).

Who needs rea medical records release?

01
Anyone who wants to access their own medical records needs a rea medical records release.
02
Certain individuals involved in the care or treatment of the person whose records are being requested may also need a medical records release.
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REA Medical Records Release is a form that allows patients to authorize the release of their medical records to a designated individual or entity.
Patients or their legal representatives are typically required to file a REA Medical Records Release form.
To fill out a REA Medical Records Release form, patients need to provide their personal information, specify the records to be released, and sign the authorization.
The purpose of a REA Medical Records Release form is to ensure that patients' medical information is released only with their consent and to the specified recipient.
Information such as patient's name, date of birth, medical record number, the specific records to be released, recipient's contact information, and patient's signature must be reported on a REA Medical Records Release form.
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