At Speedy Template, You can download Ohio Medical Records Release Form 3 . 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 The Family Medical Group in Ohio to authorize the disclosure or release of one person's protected health information.
3260 Westbourne Drive
Cincinnati Ohio 45248
Phone: (513) 389-1400
Ext 2501
Fax: (513) 619-8713
Authorization for
Release of Medical
Information
Patient’s Name:___________________________________________ Date of Birth:_________________