NC Onslow Memorial Hospital HIM0001 2022-2025 free printable template
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On slow Memorial Hospital
P.O. Box 1358, 317 Western Boulevard
Jacksonville, NC 285411358
Telephone: (910) 5772454
Office Hours Mon Fri 84:30AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION
FROM SLOW
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How to fill out NC Onslow Memorial Hospital HIM0001
01
Start by obtaining the NC Onslow Memorial Hospital HIM0001 form from the hospital's website or front desk.
02
Fill out the patient's personal information at the top, including full name, date of birth, and contact information.
03
Provide the details of the requester, if different from the patient, including their relationship to the patient.
04
Indicate the purpose of the request (e.g., to obtain medical records for personal use, for legal matters, etc.).
05
Specify the dates of service for which records are requested.
06
Sign and date the authorization section at the bottom of the form to confirm consent for the release of information.
07
Submit the completed form either in person, by mail, or through the specified electronic method outlined by the hospital.
Who needs NC Onslow Memorial Hospital HIM0001?
01
Patients wishing to obtain a copy of their medical records from NC Onslow Memorial Hospital.
02
Legal representatives or guardians needing access to a patient's medical information.
03
Researchers or individuals requiring the records for a specific purpose, as permitted under HIPAA regulations.
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What is NC Onslow Memorial Hospital HIM0001?
NC Onslow Memorial Hospital HIM0001 is a specific form or document related to healthcare services provided by Onslow Memorial Hospital in North Carolina.
Who is required to file NC Onslow Memorial Hospital HIM0001?
Typically, healthcare providers, administrators, or any authorized personnel affiliated with Onslow Memorial Hospital are required to file NC Onslow Memorial Hospital HIM0001.
How to fill out NC Onslow Memorial Hospital HIM0001?
To fill out NC Onslow Memorial Hospital HIM0001, follow the instructions provided on the form, ensuring that all required fields are completed accurately, and submit the form as per the specified guidelines.
What is the purpose of NC Onslow Memorial Hospital HIM0001?
The purpose of NC Onslow Memorial Hospital HIM0001 is to collect specific healthcare-related information for administrative, reporting, or regulatory purposes.
What information must be reported on NC Onslow Memorial Hospital HIM0001?
The information reported on NC Onslow Memorial Hospital HIM0001 may include patient details, treatment information, and other data relevant to hospital operations and compliance.
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