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Megastar Washington Hospital Center Medical Imaging School of Radiology Official Transcript Request Form Requests FROM: (Name, Last 4 of SSN #, Year of Graduation and Address) ___ ___ ___ ___ ___ ___TRANSCRIPT
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Obtain a copy of the 202-authorization-for-release-of-medical-information form.
02
Fill in your personal information, including name, date of birth, and contact information.
03
Specify the healthcare provider or facility that will be releasing your medical information.
04
Indicate the specific information or records that you authorize to be released.
05
Sign and date the form to authorize release of your medical information.

Who needs 202-authorization-for-release-of-medical-information?

01
Individuals who want to authorize the release of their medical information to a specific healthcare provider or facility.
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202-authorization-for-release-of-medical-information is a form used to authorize the release of medical information to a designated individual or organization.
Patients or their legal representatives are required to file 202-authorization-for-release-of-medical-information.
To fill out 202-authorization-for-release-of-medical-information, the patient or legal representative must provide their personal information, specify the medical information to be released, and sign the authorization.
The purpose of 202-authorization-for-release-of-medical-information is to allow the release of medical information to authorized individuals or organizations for specific purposes such as treatment or insurance claims.
The information that must be reported on 202-authorization-for-release-of-medical-information includes the patient's name, date of birth, medical record number, type of information to be released, and the name of the individual or organization receiving the information.
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