Get Authorization For Release Of Medical Information - Uwhealth

Filling out the Authorization For Release Of Medical Information form for Uwhealth is a straightforward process. This guide provides step-by-step instructions to help you complete the form accurately and efficiently, ensuring your medical information is released according to your preferences.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Authorization For Release Of Medical Information form and open it in your online editor.
2. In the patient information section, fill in your name (last, first, middle initial), street address, city, state, zip code, date of birth, and phone number. Ensure that all details are accurate.
3. For item 2a, indicate where the records will be released from by checking the appropriate box: UW Hospital and Clinics, UW Medical Foundation Clinics, both, or UW Rehabilitation Hospital.
4. In item 2b, specify what medical records you wish to disclose. Choose between a comprehensive overview of your chart, records pertaining to specific conditions, or a complete copy of your official medical record. Select one format for receiving the records: paper or DVD.
5. In item 2c, denote whether you require all radiology images or specify which images are needed based on dates or studies.
6. For item 3, indicate who within your healthcare provider's organization is authorized to disclose your medical information.
7. In item 4, specify the persons or entities outside the organization that you authorize to receive your medical information.
8. Outline the purpose of the disclosure in item 5 by checking all applicable reasons for your request.
9. In item 6, determine the expiration of the authorization. If you choose 'Other expiration event,' provide a relevant event or date.
10. Finally, sign and date the form. If someone else is signing on your behalf, specify their relationship and authority to do so.
11. After completing the form, review it for accuracy. Users can then save any changes made, download a copy, print it out, or share the form as needed.

Complete your Authorization For Release Of Medical Information online today to manage your medical records effectively.