Get Uf Health Authorization To Use Or Disclose Protected Health Information For Marketing Fundraising

Filling out the Uf Health Authorization to Use or Disclose Protected Health Information is essential for allowing the appropriate release of your health records. This guide provides detailed, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling in the student’s name and date of birth at the top of the form. It is important to ensure this information is accurate, as it identifies the individual whose health information is being disclosed.
3. Enter the address, city, state, and zip code of the student. Make sure all components of the address are correct for processing.
4. Input the home phone number for the student. This may be used for follow-up questions or confirmation.
5. Fill in the date of request and the date by which the information is needed. This helps clarify the urgency of the request.
6. Specify the sports team and grade of the student athlete. Check the appropriate box indicating whether they are on the varsity, junior varsity, or freshman team.
7. Authorized disclosures should be specified by selecting the appropriate boxes to indicate whether you authorize UF Health to release or obtain information. Fill in the school name and its address as needed.
8. Clearly state the purpose for the request by selecting 'Healthcare/Injury Prevention' if applicable. This is crucial for justifying the release of information.
9. Indicate the types of records requested, specifically focusing on any sports-related injuries treated by UF Health professionals during the school year.
10. Determine the duration of the authorization by filling out when you want this request to end. Be explicit about whether this is for a specific event or for ongoing disclosure.
11. Read the statements about your rights and the implications of signing. Ensure you understand everything before proceeding.
12. Sign the form as the student athlete. If the student is under age 18, a parent or guardian must also provide their signature.
13. Fill in the date of signing after each signature to confirm when the authorization was completed.
14. Finally, save your changes. You can download, print, or share the form as needed to finalize your submission.

Start completing your authorization form online today for a seamless health information management experience.