Get Section 34 Consent Form - Alberta Health And Wellness
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How to fill out the Section 34 Consent Form - Alberta Health And Wellness online
Filling out the Section 34 Consent Form is an essential step in allowing the disclosure of your individually identifiable health information in accordance with Alberta's Health Information Act. This guide will provide a clear, step-by-step process to help you complete the form online with confidence.
Follow the steps to fill out your consent form correctly.
- Press the ‘Get Form’ button to access the Section 34 Consent Form and open it in the editor.
- In the 'Client Information' section, carefully fill in your surname and given names as they appear on your identification. Then enter your date of birth in the specified format (day/month/year).
- Next, provide your current address in the designated area to ensure the accuracy of your contact information.
- In the section labeled 'I authorize my individually identifying health information related to:', describe the specific health information you wish to disclose, including relevant dates and details that clarify the nature of this information.
- Indicate the name of the custodian from whom you are authorizing the health information to be disclosed in the space provided.
- Clearly state the purpose(s) for which the information is being disclosed. This may include treatment, referrals, or other relevant reasons.
- Read the statement regarding your understanding of the consent. Acknowledge the risks and benefits of signing this form and your right to revoke consent at any time.
- Enter the date when you are signing the form. Include the day, month, and year in the specified sections.
- If you are signing on behalf of someone else, ensure you provide your signature as well as the printed name of the authorized representative and the source of your authority.
- Lastly, a witness must sign and print their name to validate your consent.
- Once all sections are completed and reviewed for accuracy, save your changes. You can then download, print, or share the consent form as needed.
Complete your Section 34 Consent Form online today to ensure your health information is handled as you intend.
The HIA protects your health information and governs the collection, use and disclosure of that information. You have a right to know why your health information is being collected, used and disclosed. You have the right to make an expressed wish regarding the disclosure of your health information.
Fill Section 34 Consent Form - Alberta Health And Wellness
Consent to Disclosure (Section 34). 8. Notice to Non-Custodian (Section 32(2)). 9. Please provide the reason why you want to disclose the health information (required). An example of an HIA consent form can be found here. This praccal guide is based on the Health Informafion Act and regulaons. It refers to or paraphrases provisions from these enactments. This consent is obtained in accordance with section 22(6.1) of the Alberta Health Care Insurance Act and section 34 of the Health.
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