Secure Medical Record Request

 

Price: $ 250.00

Save time and money by automating your medical health information requests, our system requires no faxing and can be completed from a smart phone, pc or mac. You receive a completed, signed, dated Standard Authorization of Use and Disclosure of Protected Health Information form.  Your patients can access the request from your free secure web page, and complete anytime, reduce faxes, reprints and shredding. If necessary you can print blank a hard copy for use from your online formcenter. Secure 256bit encrypted session ensures your data privacy. Save headaches with the automated Standard Authorization of Use and Disclosure of Protected Health Information form system.

Easy Edit Form lets you personallize in minutes.

Requirements:

  • Free Onlineformsonline.com account
  • Adobe Acrobat Reader or Google Chrome pdf reader

Standard Features Include:

  • eSign electronic signature
  • Secure 256bit encrypted interface standard.
  • NO USAGE FEES, NO MONTHLY FEES, NO SUBMISSION LIMITS
  • Easy Input Customer Side Interface, PDF form output emailed to address of choice.
  • Print unlimited paper copies on demand from your dashboard.
  • Send Me Copy for customer to receive copy by email of their completed PDF form. 
  • Automatic link created for use in your social media, email or webpage.
  • Free Parking on your OnlineFormsOnline.com personal web page for anywhere access.
  • Print QR code labels for automatic link to your form.
  • 24/7 Customer support.