Get Inova Health System Authorization To Release Form

Completing the Inova Health System Authorization To Release Form online is an important step in managing your healthcare information. This guide provides clear instructions to help you navigate each section of the form with confidence.

Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the client name in the designated field. This is the name of the person whose health information will be released.
3. Next, fill in the date of birth (DOB) of the client. This helps to confirm their identity.
4. Provide the full address of the client. This should include street address, city, state, and zip code.
5. Indicate who the information should be released to. You can add up to three names or organizations in the provided fields.
6. Specify if any information is to be obtained from another party by filling out the relevant field.
7. Next, select the type of information to be released by checking the corresponding boxes, such as intake summary, discharge summary, and treatment plan.
8. Use the notes section to provide any additional information or specify other documents if needed.
9. State the purpose for the release of information in the designated area, explaining why this authorization is necessary.
10. Ensure that you read and understand the conditions related to the disclosure of your information, including re-disclosure risks.
11. Finally, sign and date the form. If you are a representative of the client, include your name and relationship to the client in the appropriate fields.
12. After filling out the form, save the changes, and download or print a copy for your records or to share with the relevant parties.

Start completing your documents online today for easier management of your health information.