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Tel (810) 3423800 fax (810) 3423784 kcnflint@mclaren.orgtel (810) 3423840 fax (810) 3424229 protontherapy@mclaren.org4100 Beecher Rd., Flint, MI 48532 karmanos.org/flintcancerAuthorization to Release
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01
Start by downloading the McLaren Proton Form Rapy Authorization to Release Medical form.
02
Fill out the patient's personal information including name, date of birth, and medical record number.
03
Specify the information that needs to be released and to whom it should be released to.
04
Sign and date the form to authorize the release of medical information.
05
Make a copy of the completed form for your records before submitting it to the appropriate party.

Who needs mclaren-proton-formrapy-authorization-to-release-medical?

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Patients who wish to authorize the release of their medical information to another individual, healthcare provider, or organization.
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It is a form used to authorize the release of medical information for McLaren Proton therapy.
Patients or individuals who require the release of their medical information for McLaren Proton therapy are required to file this form.
The form should be filled out with the patient's personal information, the details of the medical information to be released, and the signature authorizing the release.
The purpose of this form is to allow McLaren Proton therapy to release the patient's medical information as needed for treatment purposes.
The form must include the patient's personal information, details of the medical information to be released, and the signature authorizing the release.
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