Get Cigna Hipaa Release Form 2002 2020-2025

Filling out the Cigna Hipaa Release Form 2002 online is a straightforward process that enables individuals to authorize the disclosure of their personal health information. This guide will provide clear, step-by-step instructions to help users successfully complete the form.

Follow the steps to complete the Cigna Hipaa Release Form 2002 online.

1. Press the ‘Get Form’ button to obtain the release form and open it in your editor of choice.
2. Carefully read the authorization statement at the beginning of the form. This section outlines that you are giving Cigna Healthcare permission to release specified private health information.
3. In the section labeled 'Description of Private Health Information to be released,' clearly print the type of health information you wish to share.
4. Next, review the list of categories of information. Initial next to any that you wish to include. Strike through any items you do not wish to be included, such as drug dependency or mental health issues.
5. Provide your personal identification information in the 'Identification of person authorizing release' section. This includes your name, phone number, date of birth, and social security number.
6. Fill in your address, including zip code, and any relevant member identification numbers from your Cigna member ID card.
7. If applicable, enter the details of the subscriber (if different from you), including their name and relationship to you.
8. Indicate who you authorize to receive the information by providing their names in the designated section.
9. Specify the purpose of the release at the end of the form, explaining why the information is needed.
10. Set an expiration date or event for the authorization to end. This can be a specific future date or a particular event.
11. Sign and date the form at the bottom to complete your authorization. Ensure that you also include your relationship to the member if you are signing on their behalf.
12. Once the form is filled out, review your entries for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your documents online today for a smoother process.