Get Sutter Health Form Sh-0009 2019-2025

Filling out the Sutter Health Form SH-0009 online is a vital step for requesting your health records. This guide provides clear, step-by-step instructions to ensure you can complete the process efficiently and accurately.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editing interface.
2. Indicate whether you are the patient by selecting 'Yes' or 'No.' If you select 'No,' be prepared to provide supporting documentation to confirm your authority as the patient's legal representative.
3. Fill out the patient information section, including the patient's full name, address (City, State, ZIP), date of birth, phone number, and email address.
4. Specify the healthcare provider you wish to request records from by entering their full name, address, phone number, and fax number if applicable.
5. Choose where you want the records to be sent. If they are to be sent to the patient only, check the designated box. If not, provide the recipient's full name, address, phone number, and fax or email if necessary.
6. Select the reason for requesting the records by checking the appropriate box that applies to your situation.
7. Indicate the time frame for which you are requesting records by specifying the start and end dates.
8. Select the types of records you would like to obtain by checking all relevant boxes. Provide additional details about the specific records if needed.
9. Authorize the release of any protected information contained in the records by checking the applicable boxes.
10. Indicate whether there is a deadline for your request, along with the specific date if applicable.
11. Select how you would like to receive the records, choosing one option from the provided list.
12. Complete the expiration date section if you wish to specify an alternative expiration for the authorization.
13. Sign and date the form to validate your authorization. If you are signing on behalf of the patient, include your name and relationship.
14. After filling out the form, save your changes. You can then download, print, or share the filled form as needed.

Complete your Sutter Health Form SH-0009 online today to ensure a smooth process for accessing your health records.