Unc Medical Release Form. Web to release the protected health information of the patient named above to: Web in order for medical information to be released, a written release must be signed by the requesting student.
Unc Health Care Medical Records Release Form
Click here for the english release form. These forms can be found via the “ forms ” link on the intranet home page. Web unc hospitals unc health information management attn: We cannot accept an electronic signature on release of information forms. Under federal medical privacy law. University of north carolina at chapel hill. • i may refuse to sign this authorization: Unc health care system will not condition my treatment, any payment, enrollment in a health plan, or eligibility for benefits on receiving my signature on this authorization. Web my written revocation to the medical information management department. Relmedinfo@unch.unc.edu fax fax your completed authorization form to:
University of north carolina at chapel hill. We cannot accept an electronic signature on release of information forms. These forms can be found via the “ forms ” link on the intranet home page. • i may refuse to sign this authorization: University of north carolina at chapel hill. Under federal medical privacy law. You can also view your personal health records on the healthy heels portal. The campus health medical release of information form is used for consent to sharing previous medical encounter details with campus health or transmit your campus health records. Click here for the spanish version. Click here for the english release form. The authorization form can be obtained from any unc hospitals, unc hillsborough campus or chatham hospital, or you can download a copy from the link.
