Get Authorization For Release Of Medical Information - Meriter Health ...

Filling out the Authorization For Release Of Medical Information form is an important step to ensure your health information is shared accurately and safely. This guide provides clear instructions for completing the form online, helping you navigate the necessary fields with ease.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Provide your personal information in the 'Patient Name', 'Date of Birth', 'Previous Name(s)', and 'Address' fields. Ensure accuracy in spelling and format.
3. Include your phone number in the designated field, including the area code.
4. In the 'authorize' section, clearly indicate who is authorized to use and/or release your medical information.
5. In the 'release protected health information to' section, specify the name of the person or organization receiving the information. This may be yourself or another individual.
6. Complete the 'purpose or need of disclosure' section by checking all applicable reasons for the release, such as 'Further Medical Care' or 'Patient’s Request'.
7. In the 'type of information to be disclosed' section, complete each item (a. through d.) by indicating the specific records needed, such as 'Discharge Summary' or 'Lab Results'.
8. Fill in the 'expiration date' by specifying either one year from the date signed or an alternate date/event.
9. Sign the form in the 'signature of patient' section along with the date signed. If someone else is signing, fill in the relationship and authority to do so.
10. Review all completed fields for accuracy before saving, downloading, printing, or sharing the form as needed.

Complete your medical information release form online for a seamless process.