Get Authorization For Clinical Communication - University Of Michigan

Completing the Authorization For Clinical Communication form from the University of Michigan is a straightforward process that allows for the sharing of important clinical information. This guide will walk you step-by-step through filling out the form accurately and efficiently online.

Follow the steps to complete the authorization form successfully.

1. Click ‘Get Form’ button to obtain the form and access it in an editable format online.
2. Fill in the patient's basic information. This includes the patient's name, birthdate, and medical record number (MRN). Ensure all information is accurate to prevent any issues with processing.
3. Indicate your relationship to the patient. Confirm whether you are the patient or a legally authorized representative. If you are a representative, specify your relationship to the patient.
4. In the section regarding clinical communications, list the names of the clinical personnel authorized to communicate with other parties. Include relevant details about the individuals or organizations that should receive this information.
5. Specify the information needed. Write down the dates for which the information is required and check the boxes next to the types of information that need to be shared.
6. State the purpose of this release or disclosure by selecting the appropriate reason. Be as specific as possible to ensure compliance with the patient's needs.
7. Set an expiration date for this authorization. If left blank, it will automatically expire six months from the signature date.
8. Review the section on revoking authorization. Understand the process for canceling this authorization if needed.
9. Sign the document. If necessary, have the signature of the legally authorized representative and provide their printed name along with their relationship to the patient.
10. Once you have completed all sections, save your changes, download the form, or print it for your records.

Complete the Authorization For Clinical Communication form online today to ensure efficient clinical communication.