Get Ihs Form 810, Authorization For Use Or Disclosure - U.s. Department ... - Ihs

The IHS Form 810 is a vital document used for the authorization of use or disclosure of protected health information. This guide will help you understand each section of the form and provide clear instructions to ensure proper completion, whether you are filing the document online or in another format.

Follow the steps to complete the IHS Form 810 correctly.

1. Click ‘Get Form’ button to obtain the form and open it in an appropriate editor.
2. In Section I, print your name or the name of the patient whose information is to be disclosed.
3. Move to Section II and fill in the name and address of the facility that will be releasing the information. Also, provide the name of the person or organization that will receive the information.
4. In Section III, indicate the reason for the disclosure by selecting from options such as further medical care, legal needs, research, or personal use.
5. Proceed to Section IV and check the applicable box or boxes to specify the type of information to be disclosed. Options include specific diagnoses, date ranges, or the entire medical record.
6. If the information includes sensitive topics such as alcohol/drug abuse, HIV/AIDS-related treatment, or mental health, ensure the relevant boxes are checked.
7. In Section V, if you require a specific expiration date for the authorization, write it down. After that, sign and date the form at the indicated places.
8. Finally, a copy of the completed IHS Form 810 will be provided to you for your records.

Complete the necessary forms online today to ensure your medical information is managed effectively.