Get Authorization To Release Medical Information - Sls Downstate

Filling out the Authorization to Release Medical Information form is an essential step for students at SUNY Downstate Medical Center. This guide provides clear instructions on completing the form effectively to ensure the timely release of your medical information for clinical rotations and educational training.

Follow the steps to complete the form accurately

1. Press the ‘Get Form’ button to access the authorization form online.
2. Begin by entering your name as the student or employee requesting the release of information in the designated field. Ensure that your name is spelled correctly, as this will be used to identify your medical records.
3. Next, indicate your program of study clearly in the provided space. This information helps the health service understand the context of your request.
4. In the following section, check the boxes to specify which health information you are authorizing to be released. This may include your immunization records for Measles, Mumps, Rubella, Varicella, Hepatitis B status, and tuberculin test results.
5. If applicable, provide a brief statement regarding any health condition that requires accommodations during clinical rotations. Be mindful that this information is important for your safety and that of others.
6. After completing all required fields, review your entries carefully to ensure accuracy and completeness.
7. Sign and date the form where indicated. Ensure that your signature matches the name you provided at the beginning to maintain consistency.
8. Once you have filled out the form, save your changes and choose to download, print, or share the completed form as necessary. Make sure to submit the form to the appropriate Student Health Service office.

Complete your documents online to facilitate your health clearance for clinical rotations.