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AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS AND/OR IMAGINGPATIENT NAME:___ MR#___ OTHER NAME RECORDS MAY BE UNDER (MAIDEN NAME) ___ PATIENT DATE OF BIRTH___ DATE OF SERVICE___ IMAGES/RECORDS TO BE
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01
Download the authorization-for-release-of-information-to-aim-medical form from the AIM Medical website.
02
Fill in your personal information, including your full name, date of birth, and mailing address.
03
Provide the name of the individual or organization that you are authorizing to release your medical information to AIM Medical.
04
Sign and date the form to authorize the release of your medical information.
05
Make a copy of the completed form for your records before submitting it to AIM Medical.

Who needs authorization-for-release-of-information-to-aim-medical?

01
Individuals who wish to authorize the release of their medical information to AIM Medical.
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The authorization-for-release-of-information-to-aim-medical is a form that allows the release of medical information to AIM Medical.
Patients or authorized representatives are required to file the authorization-for-release-of-information-to-aim-medical.
To fill out the authorization-for-release-of-information-to-aim-medical, you need to provide your personal information, specify the information to be released, and sign the form.
The purpose of authorization-for-release-of-information-to-aim-medical is to allow AIM Medical to access and use your medical information for treatment purposes.
The authorization-for-release-of-information-to-aim-medical must include your name, date of birth, contact information, and the specific medical information to be released.
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