Get Release Of Information - Illinois Department Of Human Services - Dhs State Il

Filling out the Release Of Information form from the Illinois Department of Human Services is essential for allowing authorized agencies to access your personal, medical, and financial information for various purposes. This guide will provide you with step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Release Of Information form online.

1. To obtain the form, click the ‘Get Form’ button and open it in your preferred document editing tool.
2. In the 'I authorize the release of medical, financial, personal and other program information by' section, specify the name of the agency that will be releasing the information. This might include the Illinois Department of Human Services, other state departments, or specific agencies involved in your service plan.
3. Next, check the purpose for which the information will be released. This could be for determining eligibility for programs, planning services and supports, or monitoring service delivery. Ensure all purposes that apply are appropriately indicated.
4. In the 'Expiration Date' field, enter the date until which this authorization remains valid. This is a crucial part of the form that must be completed.
5. Provide the name of the individual for whom the information is being released in the 'Name of Individual (print or type)' section. Ensure that the name is clear and legible.
6. After completing the name, obtain the appropriate signatures. The individual or their authorized representative must sign in the designated area. Additionally, a witness is also required to sign the form.
7. Finally, review the completed form for accuracy, then save your changes. You may download, print, or share the filled-out form as needed.

Start completing your documents online to ensure your information is shared appropriately and securely.