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AUTHORIZATION TO RELEASE MEDICAL RECORDS FROM LANIER URGENT CAREI, ___authorize Lanier Urgent Care to release my medical records to the following person or organiza on: Name: ___ Street Address: ___
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How to fill out medical record release to

01
Obtain the medical record release form from the healthcare provider or facility.
02
Fill out your personal information such as your name, date of birth, and address.
03
Specify the healthcare provider or facility that will be releasing your medical records.
04
Indicate the dates or timeframe for which you are authorizing the release of your medical records.
05
Sign and date the form to certify that you are authorizing the release of your medical records.

Who needs medical record release to?

01
Individuals who are requesting their own medical records for personal use.
02
Individuals who are transferring to a new healthcare provider and need their medical records sent over.
03
Legal representatives who are seeking medical records on behalf of a patient.
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Medical record release refers to the process of granting permission for access to a patient's medical records by authorized individuals or entities.
Typically, the healthcare provider or facility is responsible for filing a medical record release upon receiving a valid request from the patient or their authorized representative.
To fill out a medical record release, one must provide patient identification information, specify the records requested, indicate the purpose of the request, and sign and date the form.
The purpose of a medical record release is to ensure that patients can share their medical information with healthcare providers, insurance companies, or other relevant parties for treatment, insurance claims, or legal purposes.
The medical record release must include the patient's name, date of birth, details of the records being requested, the purpose of the release, recipient's information, and the patient's signature.
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Relevant keywords

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