Get Release Of Information - St. Cloud Orthopedics

Filling out the Release Of Information form allows patients to manage their health information effectively. This guide will provide you with the steps needed to complete the form online in a simple and user-friendly manner.

Follow the steps to complete your Release Of Information form.

1. To obtain the form, use the ‘Get Form’ button to access it and open it in your preferred document editor.
2. Begin by entering your personal information in the appropriate fields. Fill in your full name, date of birth, and chart number accurately to ensure the correct identification of your records.
3. In the section labeled 'I authorize,' specify the organization or individual that will be releasing your health information. Clearly state their name to avoid any confusion.
4. Next, identify the person or entity that you wish to receive your health information. Provide their name and address in the corresponding fields.
5. For the purpose of the release, select the appropriate reason from the options provided, such as 'patient’s own review' or 'insurance claim.' If you specify 'other,' please briefly explain.
6. In the 'Extent of Information to Release' section, indicate if you wish to release all dates of treatment or a specific range by filling in the 'from' and 'to' dates.
7. Mark all types of information you wish to be released by checking the relevant boxes. This includes items like physician notes, x-ray reports, and therapy notes.
8. If applicable, indicate your preferences regarding the release of sensitive information, such as substance abuse or mental health records, by initialing in the designated areas.
9. Review the understanding statement carefully and acknowledge your rights and the implications of releasing your information by signing in the designated area. Remember, digital signatures are not accepted.
10. Finally, enter today's date, and if required, include the signature of a witness if you are unable to sign the form personally.
11. After completing the form, save your changes. You can then download, print, or share the document according to your needs.

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