 |
CONSENT
FOR RELEASE OF INFORMATION
The records services department at Kearney
Clinic facilitates the release of medical information
to our patients. Medical information is released in the
form of medical reports, patient discharge summary and
selected investigation reports. The release of medical
information is subject to official approval. |
|
| |
| WHAT
IS REQUIRED FOR THE REQUEST FOR MEDICAL INFORMATION? |
| 1. |
Patient's written consent to
allow Kearney Clinic to release medical information for
a stated purpose. |
| 2. |
Payment for the information
required. The appropriate payment must accompany each
request for medical information. |
|
| |
| HOW
TO REQUEST MEDICAL INFORMATION |
Requests
for medical information can be made by downloading and completing
a Consent for Release of Information form by clicking on the
button below.
The Consent Form for Minors is a preauthorization form for treating
minors and is provided for free.
Please print a copy of the appropriate form, complete the necessary
information, and mail or fax it back to us at (308) 865-2150. |
| |
|
| |
Consent
forms are in PDF format and require Adobe® Reader®.
Download
Adobe® Reader® |
