Get Lic 605

Filling out the Lic 605 form online is an essential process for authorizing the release of medical information for clients or residents. This guide will provide you with clear and detailed steps to assist you in completing the form accurately and efficiently.

Follow the steps to complete the Lic 605 form online.

1. Click ‘Get Form’ button to obtain the Lic 605 form and open it in the editor.
2. In the first section, you will need to provide the name of the physician, clinic, hospital, hospice, home health agency, or therapist to whom the information is being released. Make sure to enter the full name accurately.
3. Next, fill in the address of the person or facility listed in the previous step. Ensure the address is complete to avoid any delays.
4. For the patient's information, enter the name of the person whose medical records you are authorizing for release. This must be the full legal name as it appears in their medical records.
5. Continuing, provide the name and address of the facility, person, or agency that is requesting this information. Double-check this information for accuracy.
6. Specify the expiration date of the authorization. This should be a clear date when this authorization will no longer be valid.
7. Next, enter the name of the client or authorized representative signing the form, along with their relationship to the person whose information is being requested.
8. Finally, provide the address of the client or authorized representative. This information is crucial for verification purposes.
9. Review all the entries you have made for completeness and accuracy. Once satisfied, you can save the changes, download, print, or share the completed form as needed.

Complete the Lic 605 form online today for a seamless submission process.