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 For Adults In Harris
Category:
State:
Multi-State
County:
Harris
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
Description
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If you have any questions or need assistance completing the Authorization, you can call (713). 970-7330. A completed Authorization for Release of Protected Health Information (PHI) form (linked above under Quick Links).Writing a Letter to Request Medical Records. Streamline how patients authorize medical treatment and procedures with our Medical Consent Form for Adults template. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form.