Get Tampa Hca Shared Service Center Hsc Release Of Information

Filling out the Tampa HCA Shared Service Center HSC Release Of Information form online can streamline the process of obtaining your medical records. This guide offers clear steps to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and have it displayed in your online document manager.
2. Begin by entering the patient’s name, date of birth, and phone number. The last four digits of the social security number are optional but can assist in identification.
3. Specify the recipient’s name, which could be a third party such as a partner or another healthcare provider. If the recipient is the same as the patient, you may write 'SELF'.
4. Provide the recipient’s address and phone number. This information is crucial for ensuring the records reach the correct individual.
5. Select the preferred method for receiving the records by checking the appropriate delivery option: paper copy, electronic media, encrypted email, unencrypted email, or provider fax number.
6. Set an expiration date for the authorization or indicate an event that signifies when the authorization ends, but do not fill in both a date and an event.
7. Clarify the purpose for the disclosure, such as for further treatment, insurance purposes, or personal use.
8. Select the hospital from which you are requesting records. You may indicate the specific facility that holds the relevant information.
9. Determine if you are requesting psychotherapy notes. If so, indicate 'Yes' and be aware a separate authorization will be needed for other records. If not, select 'No' and proceed.
10. Specify the type of information you wish to obtain. Common requests include discharge summaries, lab results, or operative information. Provide the relevant dates of service.
11. Affirm your understanding that the information may include sensitive data by initialing in the designated area.
12. Complete Section B if the request involves marketing purposes or financial exchanges. If not applicable, skip to Section C.
13. In Section C, sign and date the form. If someone is signing on behalf of the patient, they must have legal authority to do so, and appropriate documentation should be included.
14. After completing your form, save the changes. You have the option to download, print, or share the form as needed.

Complete your Tampa HCA Shared Service Center HSC Release Of Information online today and ensure your records are easily accessible!