Get Musc Video And Photography Release Form. - Medical Center ... - Mcintranet Musc

Filling out the MUSC Video And Photography Release Form is a critical step to ensure consent for your involvement in photography or videography within the Medical Center. This guide provides clear, step-by-step instructions to help you successfully complete the form and understand its components.

Follow the steps to accurately fill out the MUSC Video And Photography Release Form.

1. Press the ‘Get Form’ button to obtain the form and open it in an editing interface of your choice.
2. Begin by entering your full name in the 'Patient Name' field. Ensure that you provide the name as it appears in your medical records.
3. Input your Medical Record Number (MRN) in the designated field. This number helps identify your medical history.
4. Enter your date of birth in the corresponding section to confirm your identity.
5. Indicate the person or class of persons authorized to use or disclose the information by completing that section.
6. In the next section, specify any individuals or classes of individuals authorized to receive the information.
7. Mark the boxes next to each type of media in which you consent to participate: Photographed, Filmed, Videotaped, Interviewed, or Other. Provide details if you select 'Other'.
8. Explain the purpose of the use or disclosure of your information by selecting the relevant options provided.
9. Describe the specific protected health information that will be used or disclosed by choosing the appropriate options.
10. Fill in your address in the indicated section to ensure the accuracy of your contact information.
11. Carefully read through the consent statements. By signing, you are acknowledging your understanding and agreement. Ensure you check all boxes that apply for authorization expiration.
12. Sign and date the form in the designated area, ensuring that your signature is clear. If applicable, include the relationship to the patient in the specified field.
13. Finally, save your changes, download, print, or share the form as needed based on your preferred method of submission.

Take a moment to fill out the MUSC Video And Photography Release Form online today!