Get Patient Authorization To Disclose Certain Health Information - Aobos

This guide will help you successfully complete the Patient Authorization to Disclose Certain Health Information form required by the American Osteopathic Board of Orthopedic Surgery. Follow the step-by-step instructions to ensure your information is accurately provided and submitted.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your name in the space provided as 'Patient' to identify yourself.
3. Indicate your state of residence in the designated area.
4. Enter the name of your physician in the section labeled ‘Physician’.
5. In the provided field, specify the types of medical information you are authorizing for disclosure, including any relevant procedures or conditions.
6. Check the appropriate boxes or indicate the individuals or groups to whom the information will be disclosed, such as members of the AOBOS.
7. Review the purpose of the disclosure to ensure your understanding of why the information is being shared.
8. Acknowledge the condition regarding anonymity in examinations and publications by reading the related statement.
9. Understand your right to revoke this authorization at any point and note the suggested method for doing so.
10. Sign and date the form to affirm that you have read and agreed to the terms. If necessary, a parent or guardian can complete the section for minor patients.
11. After completing the form, save your changes, and then you can download, print, or share it as needed.

Complete your Patient Authorization form online today to ensure prompt processing of your request.