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J. L. Walton & Associates 1107 W. Main St., Ste. 201 Durham, NC 27701 N.C. Department of Insurance Permit #738 www.jlwalston.com Email: mygoodcredit jlwalston.com Phone: (800) 489-7999 Fax: (919)
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How to fill out a medical release - jl:

01
Start by providing your personal information, including your full name, date of birth, address, and contact information.
02
Next, provide the healthcare provider's name, address, and contact information.
03
Specify the purpose of the medical release, such as allowing the healthcare provider to share your medical records with another doctor or insurance company.
04
Indicate the specific dates or time frame for which you are authorizing the release of your medical information.
05
Sign and date the medical release form.
06
If necessary, have a witness sign the form as well.
07
Make a copy of the completed form for your records before submitting it to the healthcare provider.

Who needs a medical release - jl:

01
Anyone who wants to authorize the release of their medical information to another party, such as a doctor, insurance company, or legal representative.
02
Individuals seeking a second opinion or transferring their medical care to a new doctor may need a medical release to facilitate the transfer of their medical records.
03
Patients involved in legal matters, such as personal injury or workers' compensation cases, may require a medical release to provide their medical records as evidence.
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A medical release form is a document that allows an individual to authorize the release of their medical information.
Anyone who wishes to grant permission for their medical information to be shared with a specific individual or organization must file a medical release form.
To fill out a medical release form, you will need to provide your personal information, the information of the person or organization who will receive the medical information, and specify the type of information being released.
The purpose of a medical release form is to allow individuals to control who has access to their medical information and to ensure that their privacy is protected.
The information that must be reported on a medical release form includes the patient's name, date of birth, medical record number, the information being released, and the reason for the release.
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