Get Ohsu Roi

Filling out the Oregon Health & Science University's Release of Information (Ohsu Roi) form online can streamline the process of authorizing the use and disclosure of protected health information. This guide provides clear, step-by-step instructions to ensure that users can complete the form accurately and efficiently.

Follow the steps to successfully complete the Ohsu Roi form online.

1. Press the ‘Get Form’ button to retrieve the form and open it in your chosen editing platform.
2. Begin by filling out the patient identification area with the required information, including account number, medical record number, name, and birthdate.
3. In the 'Authorization to use and disclose protected health information' section, clearly specify the name of the person, entity, or facility that is disclosing the information.
4. Provide the complete address of the disclosing entity, including city, state, and zip code.
5. Detail the specific health information you wish to be released. Check the appropriate boxes for items such as physician reports, labs, billing, and other necessary documents.
6. If outpatient practice or clinic records are needed, specify the practice or clinic by referring to the provided list.
7. Indicate the recipient's name and address who will receive the disclosed information.
8. Describe the purpose of the information disclosure by checking the applicable box or providing specific details.
9. If applicable, initial next to the types of sensitive information that will be disclosed, such as HIV/AIDS information or mental health information.
10. Understand that signing the authorization is not mandatory for health care services, but it is required for disclosures intended for other entities.
11. Specify an expiration date for the authorization, or it will default to one year from the signing date.
12. Sign the authorization and provide the date of signing. If signing on behalf of another person, include a description of your authority.
13. Once all sections are complete, you can save your changes, download, print, or share the form as necessary.

Take the first step towards managing your health information by completing the Ohsu Roi form online today.