Get Authorization To Disclose/receive Client Medical ... - Comtrea

Filling out the Authorization To Disclose/Receive Client Medical Information form is an essential step in managing your medical records. This guide will provide you with clear and supportive instructions to complete the form effectively and ensure your information is handled correctly.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the digital editor.
2. Begin by entering the client’s name in the designated field. Make sure the spelling is accurate.
3. Fill in the date of birth in the specified section. Use the format of month, day, and year.
4. Input the social security number in the provided space, ensuring no numbers are omitted.
5. In the section for services received, indicate the relevant dates during which the client received services.
6. Check all applicable boxes under 'The specific information to be disclosed/received' to specify what medical information you wish to authorize for disclosure.
7. Identify whether the information will be disclosed to or received from the designated facility or individual by filling in their name and address.
8. Indicate the purpose of the disclosure by checking all relevant reasons listed in the form.
9. Read the confidentiality statement carefully before signing. This ensures you understand the implications of your authorization.
10. Sign and date the form at the bottom where instructed. If necessary, a witness may also sign.
11. Finally, save your changes, download the completed form, print it, or share it as needed.

Complete your authorization online today to manage your medical information effectively.