Follow the steps to fill out the form correctly

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In the first section, enter the name of the person whose HIV test results will be released. Ensure that the name is spelled correctly and matches any official documentation.
3. In the second section, provide the name and address of the organization that is authorized to release the HIV test results. This includes filling out the organization’s name and its complete address.
4. In the next section, list the person(s) or organization(s) that will receive the HIV test results. You can include multiple entries (up to three) if necessary.
5. Specify the expiration of this authorization. You can provide a specific date or indicate a particular event that will cause the authorization to expire.
6. Mention the reason for signing the release of confidential HIV test results. Remember that signing this form is not required for treatment, payment, enrollment, or eligibility for benefits.
7. If applicable, provide the purpose for the need of disclosure.
8. At the bottom of the form, there are signature fields. Ensure the test subject, or their legally authorized representative, signs and dates the form. Include the print name and relationship of the authorized person if signing on behalf of the test subject.
9. Review the completed form carefully for accuracy before saving changes, downloading, printing, or sharing it as needed.

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