Get I Authorize Davita Medical Group To Release Protected Health Information From The Following

Filling out the I authorize DaVita Medical Group to release protected health information form online is a straightforward process. This guide provides step-by-step instructions to help you complete the form accurately and securely.

Follow the steps to complete the authorization form online

1. Click the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Enter your personal information in the designated fields. This includes your name, birth date, social security number, medical record number, and phone number.
3. Authorize the DaVita Medical Group by checking or marking the specific locations from which you request protected health information to be released.
4. Initial next to each type of information you wish to be disclosed. Options include medical records, behavioral health information, substance abuse treatment history, and HIV/AIDS information.
5. Specify the time periods for each type of information you wish to release, ensuring to detail the start and end dates.
6. In the purpose section, select the reason for the disclosure, such as continuing medical care or insurance claim.
7. Fill in the information of where you would like the records sent, including the recipient's name, address, and fax number if applicable.
8. Sign and date the authorization at the bottom of the form and provide the description of authority if you are signing on behalf of someone else.
9. Ensure the form is saved, and you can choose to download, print, or share it as needed.

Complete your form online today to ensure a smooth and efficient process for your health information release.