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M3132 Rev. 3/12 Patient Name: Medical Record Number: AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION AT DUKE UNIVERSITY MEDICAL CENTER* Date of Birth: Phone Number: If mailing this form please

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Make sure you have all the necessary documents and information:

1. Personal identification (such as driver's license or passport)
2. Health insurance details
3. Referral or authorization forms, if required
4. List of medications and medical history

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1. Call the hospital's main line or visit their website to find the appropriate department or clinic for your specific needs.
2. Consider scheduling an appointment or consultation in advance to streamline the process.

Patient registration:

1. Upon arrival at Duke University Hospital, locate the registration desk or reception area.
2. Provide your personal information and any required forms or paperwork.
3. You may be asked to verify your insurance, coverage, and payment options.

Check-in at the specific department or clinic:

1. Follow the instructions provided or ask hospital staff for assistance.
2. Be prepared to provide any necessary additional information or medical history relevant to your visit.

Follow any specific instructions:

1. If you have been instructed to fast before certain tests or procedures, make sure to follow these guidelines.
2. Take any prescribed medications as directed, unless advised otherwise by your physician.

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Patients seeking advanced medical care and specialized treatments:

1. Duke University Hospital is renowned for its expertise in various fields of medicine, including cardiology, oncology, neurology, and more.
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1. Duke University Hospital boasts a skilled team of surgeons who perform intricate surgical interventions, including organ transplants, orthopedic surgeries, and more.
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1. Duke University Hospital offers a wide range of medical services and facilities, including diagnostic imaging, emergency care, rehabilitation, and follow-up care.
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What is duke university hospital?

Duke University Hospital is a teaching hospital affiliated with Duke University in Durham, North Carolina.

Who is required to file duke university hospital?

All hospitals, medical facilities, and healthcare organizations are required to file Duke University Hospital.

How to fill out duke university hospital?

Duke University Hospital can be filled out online through their official website or submitted in person at their administrative office.

What is the purpose of duke university hospital?

The purpose of Duke University Hospital is to provide high-quality medical care, conduct research, and educate future healthcare professionals.

What information must be reported on duke university hospital?

Information such as patient demographics, medical procedures performed, diagnoses, and outcomes must be reported on Duke University Hospital.