Unc Medical Release Form. 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. Unless otherwise revoked, this authorization will expire on the following date, event, or condition:
Unc Medical Records Release Form
Web my written revocation to the medical information management department. Under federal medical privacy law. Web in order for medical information to be released, a written release must be signed by the requesting student. Web campus health release of information form. • i may refuse to sign this authorization: These forms can be found via the “ forms ” link on the intranet home page. Web unc hospitals unc health information management attn: Click here for the spanish version. We cannot accept an electronic signature on release of information forms. 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.
Unless otherwise revoked, this authorization will expire on the following date, event, or condition: University of north carolina at chapel hill. Web unc hospitals unc health information management attn: Click here for the english release form. We cannot accept an electronic signature on release of information forms. Relmedinfo@unch.unc.edu fax fax your completed authorization form to: Web my written revocation to the medical information management department. Web campus health release of information form. Web to release the protected health information of the patient named above to: Click here for the spanish version. Under federal medical privacy law.
