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AUTHORIZATION TO USE AND/OR DISCLOSE HEALTH INFORMATION Dakota Pediatrics 3636 N First Street, suite 120, Fresno, CA 93726 Phone: (559) 2244365 Fax: (559) 2244354 Patients Name: Date of Birth: Completion
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How to fill out wwwsutterhealthorgpdfmedical-release-formmedical record authorization form

01
Visit the website www.sutterhealth.org and navigate to the 'Forms' section.
02
Look for the 'Medical Release Form' or 'Medical Record Authorization Form' in the list of forms available.
03
Download the form in PDF format.
04
Open the downloaded form using a PDF reader software.
05
Read the instructions carefully to understand the information required.
06
Fill in your personal details like name, date of birth, address, and contact information.
07
Provide specifics about the medical records you wish to authorize access to, such as the name of the healthcare provider, dates of treatment, and types of records.
08
Review the form to ensure all required fields are completed.
09
Sign and date the form.
10
Make a copy of the completed form for your records.
11
Submit the form according to the instructions provided, whether it's mailing it to a specific address, hand-delivering it to a healthcare provider, or submitting it online if that option is available.

Who needs wwwsutterhealthorgpdfmedical-release-formmedical record authorization form?

01
Anyone who wants to authorize the release of their medical records from Sutter Health needs to fill out the medical record authorization form. This can include patients who are transferring their care to a new healthcare provider, individuals who need their medical records for legal or insurance purposes, or family members who are acting on behalf of a patient.
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The wwwsutterhealthorgpdfmedical-release-form is a document that allows an individual to authorize the release of their medical records.
Any individual who wishes to give permission for their medical records to be released to a specific person or organization.
The form typically requires the individual's name, date of birth, contact information, the specific information to be released, and the name of the person or organization receiving the information.
The purpose of the form is to ensure that medical records are only shared with authorized individuals or organizations.
The form typically requires the individual's name, date of birth, contact information, the specific information to be released, and the name of the person or organization receiving the information.
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