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Filling out the TALLADEGA COUNTY SCHOOLS HIPAA authorization for release of information form is a straightforward process. This guide will lead you through each section of the form to ensure that you provide all necessary information accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Input the patient’s name in the format of last name, first name, and middle initial. Fill in the patient’s address and phone number accurately.
3. Next, move to the section titled 'This Authorization applies to the following Information.' Choose either 'All information' or specify particular records by checking the appropriate box.
4. If you select specific records, indicate the treatment dates by filling in the 'From' and 'To' fields with the correct month, day, and year.
5. In the next section, provide details about the person or organization releasing the information, including their address and phone number.
6. Then, fill out the information for the person or organization that will receive the information, also including their address and phone number.
7. Select the purpose of release by checking 'Continuity of Treatment' or 'Other,' and specify if necessary.
8. Review the authorization statement and ensure you understand its implications regarding the release of information and your rights.
9. Finally, complete the signature section. The parent or legal guardian should print their name, provide a signature, and enter the date. If applicable, the patient aged 14 or older should sign as well. Ensure a witness also signs if required.
10. Once all steps are completed, you can save changes, download, print, or share the form as needed.

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