Get Sh 48 Form For Smh - Urmc

Filling out the SH 48 Form for Strong Memorial Hospital and URMC is a straightforward process that allows users to authorize the release or disclosure of their medical and behavioral health information. This guide provides clear, step-by-step instructions to assist users through each section of the form.

Follow the steps to complete the SH 48 Form online.

1. Click the ‘Get Form’ button to access the SH 48 Form and open it in your editor.
2. In the first section of the form, enter the patient’s name, date of birth, and address. Ensure that all information is accurate and clearly printed.
3. Provide the patient’s phone number and city, state, and ZIP code to facilitate communication.
4. Indicate your preference regarding how the records will be shared by checking the appropriate boxes for sending or receiving copies of the records.
5. Fill out the name, address, and contact details of the provider or facility that will be involved in the sharing of information.
6. State the purpose of the records request by checking the relevant options, such as healthcare, insurance, or other.
7. In the next section, specify the types of records or information you are requesting by selecting all applicable options.
8. If applicable, input the dates of inpatient admissions or outpatient visits, and describe any specific information or reports needed.
9. Clarify the duration that this authorization is valid by selecting the relevant options, whether for a specific request, one year, or until a specified date.
10. Finally, review the completed form for accuracy, provide the signature of the patient or representative, and date it. Indicate the relationship to the patient if applicable.
11. Once all fields are filled out, save your changes, download, print, or share the completed SH 48 Form as needed.

Complete your SH 48 Form online today to ensure your health information is managed smoothly.