Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Medical Authorization Form Template In Sacramento
Category:
State:
Multi-State
County:
Sacramento
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
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Find forms and information on how to request medical records from the Health Information Management Department at UC Davis Health. Patients have the right to receive a copy of their medical records or inspect them, but requests must be made in writing using the forms below.County of Sacramento Authorization to Obtain or Release Client Health Records. Please call for further information about these circumstances. If none of these circumstances apply, please complete the form. A signature and date are required for the authorization to be valid. Do not use for patient copies of or access to their medical records. Patients should go to kp. Contact your healthcare provider or insurance company to request a form.