Record Release to Frontier Family Practice

The document titled “Record Release to Frontier Family Practice” serves as an authorization form for the release of medical records to Frontier Family Practice. It requests patient information such as full name, date of birth, address, phone number, and the date the records are needed. It specifies the facility from which the records are to be released, with Frontier Family Practice as the receiving entity. The form includes options for the type of information required, including progress notes, hospital records, X-rays, and others. It highlights the inclusion of comprehensive health care information, including sensitive data. The authorization remains valid for six months, subject to revocation in accordance with Montana State Statute, and requires patient and guardian (if applicable) signatures for consent.