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MEDICAL RECORDS RELEASE AND HIPPO DISCLOSURE4400 Falls of Reuse Rd., Suite 101 | Raleigh, NC 27609 (919) 3866866 | Fax: (919) 3866867Patient Name___ DOB ___ MR#___ Social Security ___ Telephone ___
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How to fill out medical records release and

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How to fill out medical records release and

01
Obtain the medical records release form from the healthcare provider or facility.
02
Fill out the patient's personal information including name, date of birth, and contact information.
03
Specify the dates of the medical records to be released.
04
Provide the name and contact information of the recipient of the medical records.
05
Sign and date the form, and ensure all necessary information is completed accurately.
06
Submit the completed form to the healthcare provider or facility.

Who needs medical records release and?

01
Medical professionals who need access to the patient's medical history for treatment purposes.
02
Insurance companies requesting medical records for claims processing.
03
Legal professionals involved in personal injury lawsuits or medical malpractice cases.
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Medical records release is a form that allows the release of a patient's medical information to a specified individual or organization.
The patient or their legal guardian is usually required to file a medical records release form.
To fill out a medical records release form, the patient must provide their personal information, specify the recipient of the medical records, and sign the form.
The purpose of a medical records release form is to authorize the release of medical information to a specified party for purposes such as medical treatment, insurance claims, or legal proceedings.
The medical records release form typically requires information such as the patient's name, date of birth, medical facility, date of records to be released, and the purpose of the release.
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