[Verified Answer]: Using a Microsoft word document or PDF,…

Using a Microsoft word document or PDF, create and design a simple, generic medical release form that could be useful for a healthcare practice. Some facilities have a letterhead with logos for documents in the facility. For this assignment, you can create a letterhead with just the name of the facility and the words “Medical Release Form” under the facility name. This should be in Bold using 18-pt font. Your form must include the following information (be sure blanks are included for the information: In a separate document, explain why this document is necessary and how it is legally being used in the medical facilities. 1st Section Patient’s first and last name Date of Birth SSN Full Address Phone numbers (Home and Cell/Work) 2nd Section: This section can be titled “Information Requested From” and includes the information for the facility you work for. Note: this can be a prefilled section since it will be the standard document for your facility and should include the following information: Name of Facility Address of Facility Office Phone Office Fax 3rd Section: This section can be titled “Send Information To” and includes the information to whom you are sending the form to in order to obtain the records and should include the following: Name of Facility Address of facility Office Phone Office Fax Section with check boxes (that need to be checked) that state how you want to receive the information: Send by Mail or Send by Fax A list of items being requested so that the facility in which the records are being requested will know exactly what to send. Leading blanks should be included so that staff could mark an “X” next to what is being requested. ______ Entire Medical Record ______ Hospital Records ______ Lab Results ______ X-rays or MRIs 4th Section: Create a paragraph in which the patient would need to print his or her first name granting permission for the release of their information. **You can research this information to get a general idea of what needs to be stated, but your statement must be original. Last section: This section should include an area in which the patient should print their first and last name and also sign their first and last name. The document should also be dated. Be sure to include blanks for this section. Submit completed document as an attachment to the dropbox.