Get Privacy Consent Form - Hawthorne Medical Associates

Filling out the Privacy Consent Form is an essential step for ensuring your health information is shared according to your preferences. This guide will walk you through each section of the form to help you complete it accurately and efficiently.

Follow the steps to complete your Privacy Consent Form

1. Click ‘Get Form’ button to access the form and open it in the online editor.
2. In the first field, enter your patient’s name as it appears on your identification. Ensure it is printed clearly.
3. Next, fill in your date of birth in the specified format to confirm your identity.
4. You will find a section listing family members and caregivers. For each person you wish to authorize, provide their name and relationship to you. If you need more space, you might indicate additional family members in a separate note.
5. If you do not want any information released to family members or caregivers, please initial in the designated space provided.
6. When you reach the section for signature, either provide your signature or the signature of a legally authorized individual. Indicate the relationship to the patient if someone other than the patient signs the form.
7. Finally, review all entries for accuracy and completeness. After verifying your information, you can save your changes, download a copy, print it, or share it as needed.

Complete your Privacy Consent Form online today to ensure your health information is handled according to your preferences.