Authorization to Obtain Medical Records and Billing Information
This Authorization to Obtain Medical Records and Billing Information will authorize an attorney to obtain a client's medical and billing information. This authorization contains the name of the client, medical provider who possesses the information and purposes for which the information can be used. It also spells out that the client may revoke the authorization at any time. A written Authorization to Obtain Medical Records and Billing Information is necessary in order for an attorney to obtain this needed information.
This Authorization to Obtain Medical Records and Billing Information contains:
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This attorney-prepared packet contains:
This Authorization to Obtain Medical Records and Billing Information contains:
- Authorization/Entity: Entity to whom the authorization is given and the types of information to be provided;
- Purpose: Sets out that the information is for use in connection with a legal claim or proceeding;
- Revocation: This authorization can be revoked at any time by the client;
- Signature: Client/Patient must sign and date this agreement in order for it to be effective.
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This attorney-prepared packet contains:
- General Instructions
- Authorization to Obtain Medical Records and Billing Information
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Product Specifications
| Product | Authorization to Obtain Medical Records and Billing Information |
| Country | United States |
| State | All |
| Pages | 2 |
| Dimensions | Designed for Letter Size (8.5" x 11") |
| Printer compatibility | Designed to print on all ink-jet and laser printers |
| Editable | Yes (.doc, .wpd and .rtf) |
| Format |
Microsoft Word Adobe PDF WordPerfect Rich Text Format |
| Platform | Windows Compatible Mac Compatible Linux Compatible |
| Availability | In Stock. Instant Download |
| Usage | Unlimited number of prints |
| Category | Releases |
| Product number | #28067 |
| Download time | Less than 1 minute (approx.) |
| Document Access | Via secret online address Email with download links Email with attachment upon request |
| Refund Policy | 60 days, no-questions asked, 100% money back guarantee |
| Support | Customer support 1-800-959-5899 Online support Additional Help |
Our Promise to You:
We provide accurate, legal and secure forms. All of our forms are prepared by lawyers, can be downloaded and accessed immediately, and are backed by a 100% money back guarantee – if you are dissatisfied, in any way, you get your money back.
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