Get Ocf-5: Permission To Disclose Health Information - Effective As Of ... - Fsco Gov On

The OCF-5 form, titled Permission To Disclose Health Information, is essential for individuals involved in automobile accidents occurring on or after January 1, 1994. This form allows for the legal collection and sharing of health information necessary for assessing treatment and benefits eligibility.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the OCF-5 form and open it in your preferred editor.
2. Begin by filling in your applicant information in Part 1. Enter your last name, first name, and initials. Provide your birth date in the specified format (YYYY-MM-DD), along with your province, postal code, home telephone, work telephone, and extension.
3. Next, complete Part 2 by providing the insurance company information. Include the claim number, policy number, date of the accident, and additional details requested, such as the name and contact information of the insurance company representative.
4. In Part 3, add the details of your treating health professional. Include their name, profession, address, city, and telephone number, alongside any fax number if applicable.
5. Review the authorization statement carefully, ensuring that you understand the implications of sharing your health information. This section establishes consent for your health professional to disclose your health condition details to your insurer or other appointed professionals.
6. Proceed to Part 4, where you must sign the form. Print the name of the applicant or substitute decision maker, provide your signature, and include the date in the required format (YYYY-MM-DD).
7. Once you have filled out all sections, finalize your form. You can save your changes, download the completed document, print it for your records, or share it with relevant parties as needed.

Complete your OCF-5 form online today to ensure your health information is properly documented and shared.