Get Authorization For Release/exchange Of Confidential Information

This guide provides clear instructions on how to properly complete the Authorization For Release/exchange Of Confidential Information form online. Follow these steps to ensure that all necessary information is accurately filled out.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Fill in the name of the parent, guardian, or student (if 18 or over) in the first blank field provided. This identifies who is giving the authorization.
3. Enter the full name of the student (patient) in the corresponding field. This ensures the correct individual's information is being authorized for release.
4. Input the student's date of birth and student ID to further identify the individual whose information is being shared.
5. Complete the section for the outside provider by entering the name, agency, telephone number, fax number, and email address of the provider who will receive the information.
6. Indicate which types of information may be provided to or received from the school by checking the relevant boxes.
7. Fill out the WCPSS school information, including the name, position/title, contact number, fax number, and email of the school official involved.
8. Indicate whether protected health information or educational records may be provided to the outside provider by selecting 'Yes' or 'No' in the appropriate fields.
9. Check all applicable types of information to be exchanged, including medical records, grades, treatment records, etc.
10. Specify the purpose for which this information is being provided in the designated text box.
11. Provide an expiration date or event for the authorization to indicate when the consent should no longer be valid.
12. Read and initial each statement acknowledging your rights and the nature of this authorization.
13. Finally, sign and date the form to complete the authorization process.
14. After completing the form, you can save changes, download, print, or share the document as needed.

Complete your forms online to ensure a smooth process for releasing confidential information.