Get Release Of Information - Stevens Community Medical Center - Scmcinc

Filling out the Release Of Information form for Stevens Community Medical Center is an essential process for ensuring that your health information is shared appropriately. This guide will walk you through each section of the form with clear, step-by-step instructions to make the process as straightforward as possible.

Follow the steps to complete the form accurately.

1. Begin by pressing the ‘Get Form’ button to access the Release Of Information form. This will allow you to open the document in your preferred editing tool.
2. Provide your personal information in the designated fields. Fill in your full name (last, first, middle), any previous last names, date of birth, street address, and contact details. Ensure that all information is accurate.
3. Identify the healthcare provider who has your information by checking the appropriate box. If not at Stevens Community Medical Center, indicate the name and address of the other provider.
4. Specify the recipient of the information by providing the name and address of the requestor in the designated section. Make sure to include any necessary attention lines.
5. Indicate the purpose of the information release by checking the applicable boxes. If you select 'Other,' provide a detailed description in the space provided.
6. Detail the information you wish to include in the release. You can select from the options listed or specify additional information if necessary.
7. In the area that specifies the time period for the records, enter the start and end dates for the information being requested.
8. Read the statements regarding the understanding of the authorization. Ensure you agree with them before proceeding.
9. Sign the form by adding your signature, and include the date of signing. If someone else is signing on your behalf, indicate the relationship and reason for their assistance.
10. Once all fields are completed accurately, save changes to the form. You can then download, print, or share the document as needed.

Take the next step in managing your health information by completing the Release Of Information form online today.