Health Information Authorizing Verbal Exchange of Information

A written authorization for Children's Mercy to exchange information verbally (by phone or in person) with another facility or individual must be completed and signed by the patient, parent, or legal guardian. The authorization must be signed by the patient (if the patient is 18 years or older) or the patient's legal guardian, and must be dated within one year of receipt. The authorization is good for one year, unless it is revoked. The Authorization to Exchange Medical Information is for verbal exchange only, all requests for copies of electronic and paper medical record must be requested through the appropriate standard authorization.

Authorization to Exchange Medical Information (pdf)

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