Get 18534 - Authorization For Release Of Information - Park Nicollet

Filling out the 18534 - Authorization For Release Of Information form is a key step in allowing Park Nicollet Health Services to share your medical information. This guide provides clear and detailed instructions to help you complete the form accurately and securely.

Follow the steps to effectively complete the authorization form.

1. Click the ‘Get Form’ button to access the online form and open it in your browser.
2. Begin by thoroughly reviewing all sections of the form to ensure you understand the information required.
3. In the 'Patient' section, enter your name, previous last name if applicable, street address, city, state, ZIP code, and phone number.
4. Indicate your date of birth accurately to verify your identity.
5. Select the specific types of information you wish to be released by checking the corresponding boxes (e.g., medical records, lab reports, etc.).
6. Complete the section about the purpose for the release, specifying whether it is for continuation of care, insurance, legal, or other reasons.
7. Fill in the details of the recipient (e.g., provider, insurance company) in the 'To whom should the information be released?' section, ensuring that you include the full name and contact information.
8. Choose the preferred method of delivery for the released information, selecting from options such as US Mail, secure email, or in-person pickup.
9. Review the information you have entered for accuracy and completeness before proceeding.
10. If you are the patient, sign and date the form. If you are signing on behalf of the patient, indicate your relationship and reason for signing.
11. Once satisfied with your entries, click the PRINT button to obtain a hard copy for submission or option to save or share the form electronically.

Complete your authorization for release of information online today to ensure efficient communication with your healthcare provider.