Get Healtheast Release Of Information

Filling out the Healtheast Release of Information form online is a streamlined process designed to facilitate the sharing of your medical records. This guide provides step-by-step instructions to ensure you complete the form accurately and effectively.

Follow the steps to successfully complete the Healtheast Release of Information form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editing tool.
2. Provide your personal information in the designated fields. Enter the patient name and phone number clearly. Include the date of birth and address details, such as street, apartment number, city, state, and zip code.
3. Indicate the facility from which you are requesting information. Fill in the facility name along with the address and phone number.
4. Specify the recipient of the released information. Enter the fax number if it is to be sent directly to a provider. Additionally, fill in the name, phone number, and address of the recipient.
5. Select the specific records you wish to have released by checking the appropriate boxes. Options include consultation reports, discharge summaries, laboratory reports, and more. Ensure you also specify the treatment dates.
6. Choose how you would like to receive the requested information. Select either 'Paper' or 'Electronic (Flash Drive/CD)' as your preferred media type.
7. If the release of particular sensitive information is required, specifically check the boxes corresponding to chemical dependency program records or genetic testing/evaluation.
8. State the purpose of the information release by selecting the relevant option. Include an expiration date for the authorization if needed, or it will default to one year if left blank.
9. Review the statement of authorization carefully. Make sure you understand your rights regarding the release and any revocation of authorization before signing.
10. Sign and date the form in the appropriate fields. If applicable, also include the relationship to the patient and a reason if the patient is unable to sign.
11. Finally, check the form for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Complete your Healtheast Release of Information form online today to ensure efficient access to your medical records.