Get Tampa Hca Shared Service Center Hsc - Relevo De La Informacin

Completing the Tampa HCA Shared Service Center HSC - Relevo De La Informacin form online is an essential step for individuals seeking to authorize the release of their protected health information. This guide will walk you through the necessary steps to accurately fill out the form, ensuring you provide all required information efficiently.

Follow the steps to successfully complete the online form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. In Section A, provide the required patient information, including the patient's name, date of birth, phone number, and the last four digits of their Social Security Number (optional).
3. Enter the recipient's name, ensuring it is the individual who will receive the records. If the recipient is the same as the patient, simply write 'SELF'.
4. Include the recipient’s address and phone number. If the recipient is the patient, use the patient's address.
5. Select a method of delivery for the information: paper copy, electronic copy (e.g., USB, CD), or email. If choosing email, specify whether it should be encrypted or not and provide the email address.
6. Indicate the expiration date of the authorization by selecting either a date or an event, but not both.
7. State the purpose of the disclosure, such as for further treatment, insurance purposes, legal reasons, or personal use.
8. Identify the hospital from which you need records by selecting from the provided options.
9. Answer the question regarding whether this request is for psychotherapy notes. If yes, remember that you must fill out a separate authorization.
10. Provide a detailed description of the information you are requesting, including any specific dates when applicable.
11. Initial the acknowledgment that the requested information may include sensitive data, such as mental health records.
12. Sign and date the form to certify the accuracy of the information provided and authorize the release.
13. If applicable, ensure that the legal representative's signing is accompanied by the necessary legal documentation.
14. Finalize your submission by either saving changes, downloading, printing, or sharing the completed form as needed.

Complete the Tampa HCA Shared Service Center HSC - Relevo De La Informacin form online today.