At Speedy Template, You can download Washington Medical Records 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 The Washington Endocrine Clinic to authorize the disclosure or release of one person's protected health information.
Michael J. West, M.D., Ph.D.
Board Certified in Endocrinology, Diabetes and Metabolism
Donna Westervelt, MS, CRNP, CDE
Diabetologist
Tammy Peng, RD, LD
Registered Dietitian
Medical records release form
This form is to be used to obtain a FULLcopyof your entire chart
for yourself or to have medical records transferred or sent to another physician.
Patient's Name___________________________________________Patient's Date of Birth: _______________