Get Form - Patient Consent For Phi 040303.pdf. Pass The Tablet Please

Filling out the Patient Consent for Use and Disclosure of Protected Health Information form is essential for allowing your healthcare provider to manage your health information. This guide provides clear, step-by-step instructions tailored to assist users in completing the form accurately and efficiently.

Follow the steps to complete the consent form smoothly.

1. Press the ‘Get Form’ button to access the form and have it opened in a digital editing tool for completion.
2. Begin by providing your full name in the designated field, ensuring that it is spelled correctly as it appears on your medical records.
3. Proceed to read the consent statement carefully, ensuring you understand the scope of what is allowed concerning the use and disclosure of your protected health information.
4. Next, sign the form where indicated, confirming your consent for Acute Family Medicine Clinic, Inc. to use and disclose your health information.
5. If applicable, fill in the name of a legal guardian in the space provided, along with their signature if you are not completing this form for yourself.
6. Enter the date on which you are completing the form in the specified field.
7. Review all completed fields for accuracy and ensure your personal information is correct prior to finalizing the document.
8. Finally, save your changes, and choose whether to download, print, or share the completed form as needed for your records or to submit to the clinic.

Complete your Patient Consent form online today to ensure your health information is handled with care and efficiency.