Get Consent For Release Of Protected Health Information Phi

Filling out the consent for release of protected health information PHI is an important step in managing your health records securely. This guide provides a clear and supportive walkthrough of the process to ensure your information is shared accurately and safely.

Follow the steps to complete your consent form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the member information section. Provide the full name, date of birth, address, member ID, group number (if applicable), and preferred phone number. Select whether it is a home or cell phone number.
3. Select the type of information you want to authorize for release. You can choose either 'Full Disclosure' for all protected health information or 'Limited Disclosure' to specify certain details. If you select 'Limited Disclosure,' provide the specific product types or conditions applicable.
4. Indicate the recipient of the PHI by filling in their name, date of birth (if applicable), address, email, and phone number. Choose the relationship to the individual or organization receiving the information.
5. Review the consent acknowledgment section. Make sure you understand the expiration of your consent, the process for cancellation, and that signing the authorization is not mandatory for treatment decisions.
6. Sign the form, noting whether you are signing as a member or a legal representative. If you are a legal representative, remember to attach the necessary authorization documents.
7. After completing the form, ensure all information is accurate, then either fax it to 1-800-633-8188 or mail it to Humana Insurance Company, P.O. Box 14168, Lexington, KY 40512-4168.

Complete your consent form online today to ensure your protected health information is shared as needed.