Get Ozark Center Release Form - Freeman Health System

Filling out the Ozark Center Release Form is a straightforward process that ensures your consent for the release of important health information. This guide will walk you through each section of the form, making it accessible for everyone.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in a suitable online editor.
2. In the first section, you need to provide your name and date of birth. Fill in your full name and ensure that the date is written accurately.
3. Next, specify the individual or facility authorized to receive your information. Be clear and precise in writing the full name and address of the person or organization.
4. Indicate which records you consent to release. You can select from categories such as medication notes, psychiatric evaluations, and progress notes. If there are other records you wish to include, specify them in the provided section.
5. Identify any exceptions by listing specific types of records you do not wish to disclose. Options may include details related to mental health conditions, substance abuse treatment, or HIV status.
6. Decide if you allow the faxing of your information and select 'Yes' or 'No'.
7. Fill in the complete dates of service requested. Be sure to be as specific as possible to avoid issues.
8. State the purpose of the information release clearly in the designated space.
9. Sign and date the form. If you are not the subject of disclosure, specify your authority to sign, which may include being a parent, guardian, or designated representative.
10. If required by law, include any additional witness signatures and dates.
11. Review all entries for accuracy before proceeding to save changes, download, or print the completed form.

Complete your Ozark Center Release Form online today to ensure your health information is handled promptly and accurately.