Get (this Authorization Complies With Hipaa)

Completing the authorization to release medical records is an important step in managing your healthcare. This guide will provide you with clear instructions on filling out the form online, ensuring that you understand each section and its significance.

Follow these steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred method.
2. In the section for the printed name of the patient, clearly enter your first, middle, and last name as it appears on your official documents.
3. Enter your birthdate in the format mm/dd/yyyy to confirm your identity.
4. Fill in your complete address consisting of street address, city, state, and zip code.
5. Provide your phone number and email address, ensuring that the information is current and accurate for communication.
6. If applicable, enter the printed name of your guardian or legal representative, along with their address, phone number, and email.
7. Authorize any health care professional or entity as specified by checking the appropriate boxes and providing the names and contact information necessary.
8. Specify the person or organization that will receive your medical records, ensuring their contact details are correct.
9. In the section regarding the health information to be released, list the specific types of medical records you authorize for disclosure.
10. Select the reason for the release of information by checking the relevant boxes that apply to your situation.
11. Read the acknowledgment statement, sign the form to agree to the terms, and provide the date of signing.
12. If applicable, describe the authority of any personal representative signing on your behalf.
13. Finally, review the form for accuracy. Once complete, save your changes, and choose to download, print, or share the form as needed.

Complete your authorization form online to ensure efficient communication of your health information.