![]() The information may be mailed or even faxed. In addition, the facility name must be clearly stated as well as a current address and phone number.įinally, the letter must contain accurate information which states where to release information. A request of this nature must be done in a certain way in order for the request to be honored.Ī Letter of Authorization to Release Medical Records must request the patients name, birth date, current address as well as the reason for disclosure. There are a number of sample medical authorization letters/templates available online. If you need more than one copy, ask your provider how much each copy will cost and decide whether you will make the copy yourself or ask your provider to do it for you.ĭo you want your provider to send information that they keep on paper, or in another non-electronic format, to another person? If so, you will need to fill out an “authorization” form, and your provider can charge a higher fee.Writing an Authorization for Releasing Medical Records can be done in a variety of ways. When you send in the request for your health record, ask your provider how much it will cost to get your record.
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