Get Authorization For The Release Of Phi By Utmb - Ispace - Utmb Health

Filling out the Authorization For The Release Of PHI by UTMB - ISpace - UTMB Health is an important step in managing your personal health information. This guide provides you with clear instructions to ensure that you understand each section of the form and can complete it seamlessly online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s information in the designated fields. This includes the name, date of birth, address, and phone number. Ensure that all details are accurate to prevent any issues with the release of information.
3. Decide on the method of receiving the protected health information (PHI). You can choose to receive it by mail, fax, or email. Indicate your choice by checking the appropriate box and provide the required details, such as the address for mail, fax number, or email address.
4. If you choose email as your preferred method, acknowledge the risks associated with unencrypted email communications by reviewing the provided information. This section highlights the potential exposure of your PHI if intercepted.
5. Select the specific records you authorize to be released. You can choose 'Entire Medical Records' or 'Partial Records' and specify the dates for the records. Additionally, provide a description of the records if needed.
6. Indicate the expiration of the request. You can select whether this request is a one-time release or if it should continue until you withdraw it in writing.
7. Finally, sign and date the form. If you are signing on behalf of the patient, provide your name and relationship to the patient.
8. After completing the form, save your changes, and consider downloading or printing it for your records before submitting it to UTMB via mail, fax, or email as instructed.

Complete your document online today to ensure the timely release of your health information.