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 For Minor Child In Riverside
Category:
State:
Multi-State
County:
Riverside
Control #:
US-00426
Format:
Word;
Rich Text
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This authorization is made pursuant to California Family Code Section 6910. Signature: Date: ______.To obtain a copy of your medical records, please follow the instructions below: 1. Download and complete the authorization form. You will need to complete a written authorization form to have your medical records faxed or mailed to your provider.