Get Altru Release Of Information

Filling out the Altru Release Of Information form online is a straightforward process that ensures your medical records can be properly handled. This guide will help you navigate each section of the form, providing step-by-step instructions to facilitate your completion of the document.

Follow the steps to successfully complete the Altru Release Of Information form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the first section, you will need to print your legal name as identified in official documents. Include your birth date and any previous names for accurate identification.
3. Next, provide your current address, including city, state, and zip code, along with phone numbers for home and work. This information helps in contacting you regarding your records.
4. Indicate the source of records by filling in the name of the clinic or organization along with their address and contact information. This specifies where your records are being released from.
5. Then, specify the recipient of your records. Include details of the organization or individual to whom the records will be sent, along with their address and phone number.
6. In the section for information to be released, you can denote specific records required. By default, it is for one year unless specified otherwise.
7. If applicable, initial next to any sensitive records you authorize for release, such as mental health records or chemical dependency information.
8. You will then answer whether radiology disks are needed and indicate a date by which the records are required.
9. Choose the purpose for which you need the records, like continued care or personal use, and check the appropriate method for release (oral, written, FAX, etc.).
10. Finally, read the consent information carefully. Your signature, printed name, and the date are required for authorization. If someone else is signing on your behalf, indicate the reason.
11. Once you have completed all sections, save your changes, and choose whether to download, print, or share the form as needed.

Complete your documents online today for a smooth and hassle-free process.