Get Release Of Information Form - Brighton Center For Recovery - Brightonrecovery

Filling out the Release Of Information Form for the Brighton Center for Recovery is an essential step for individuals who wish to authorize the sharing of their health information. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately online.

Follow the steps to complete the form online with ease.

1. Click the ‘Get Form’ button to access the Release Of Information Form, allowing you to open it in your preferred editor.
2. Enter your full name and date of birth in the designated fields. This information is vital for proper identification.
3. In section #1, indicate whether you want to release, obtain, or exchange information by placing your initials in the appropriate box.
4. Provide the requested recipient's details in the fields provided. This includes the first name, last name, organization, street address, city, state, zip code, phone number, and fax number if applicable.
5. In section #2, carefully select each type of information you want to be disclosed by initialing the boxes next to the respective items. Make sure every relevant type is initialed.
6. In section #3, indicate the purpose for the disclosure by initialing each applicable reason. This may include aftercare planning, continuity of care, or any other reason that fits your situation.
7. Review the section about revocation, expiration, and the non-conditioning of treatment related to this authorization, ensuring you understand your rights.
8. Sign and date the authorization at the bottom of the form. If a legal representative is signing, they should also provide relevant documentation.
9. After completing the form, save your changes. You may then download, print, or share the form as needed to ensure it gets to the Health Information Department effectively.

Start filling out your Release Of Information Form online today to manage your health information effectively.