At Speedy Template, You can download Missouri Medical Record Release Form 1 . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
This form is provided by Taylor Health and Wellness Center of Missouri State University to authorize the disclosure or release of one person's protected health information.
TAYLOR HEALTH AND WELLNESS CENTER
Missouri State University
901 S. National Avenue, Springfield, MO65897
Telephone: (417) 836-4000 Fax: (417)836-4133
http://health.missouristate.edu
AUTHORIZATION TO DISCLOSE/RELEASE OR OBTAIN MEDICAL RECORDS
All disclosures are in compliance with Federal and State laws, including the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), governing the use and disclosure of Protected Health Information (PHI).