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AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION Patient Name: ___ Birth Date: ___ Maiden/Prior Names: ___ Current Phone #: ___ Current Address: ___ Last 4 of SS#: ___ To be released to or
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How to fill out name attention to

01
Start by writing the full name of the person or organization you want to address the letter or package to.
02
If it is a formal letter, make sure to include the appropriate title and salutation (e.g., Mr., Mrs., Dr., etc.).
03
Double check the spelling of the name to avoid any errors.
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Include any additional information, such as an apartment number or company name, if necessary.
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End with the city, state, and ZIP code for proper delivery.

Who needs name attention to?

01
Anyone sending a letter, package, or correspondence that requires direct attention to a specific individual or organization.
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Name attention is a field used to indicate who or which department should receive or handle correspondence or inquiries.
Anyone submitting a form or document that requires follow-up action or response should include a name attention.
Simply write the intended recipient's name or department in the designated field on the form or document.
The purpose of name attention is to ensure that correspondence reaches the appropriate person or department for timely handling.
The information to be reported on name attention includes the name of the intended recipient or department.
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