Get Form 6700

Filling out Form 6700 online can be a straightforward process when you have clear guidance. This form is essential for authorizing the release of your health information, ensuring that your records are shared securely and with the right parties.

Follow the steps to complete the Form 6700 online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Enter the patient’s name and date of birth in the designated sections. Make sure this information is accurate, as it is crucial for identifying the correct medical records.
3. Fill in the home address of the patient, along with their phone number. This information is necessary for communication regarding the release of records.
4. In the 'Information to be released' section, indicate the date(s) of service and select the types of records you wish to authorize for release by checking the appropriate boxes.
5. For specific confidential information, sign your initials next to each category you agree to be released. This includes sensitive information such as HIV/AIDS-related information and mental health records.
6. Specify who the information should be released to, whether it is yourself, a representative, or a specific organization. Fill in all required details, including the organization name and contact information if applicable.
7. Set an expiration date for this authorization. Ensure this date is clearly indicated as it determines how long this authorization remains valid.
8. Review and acknowledge any associated fees for obtaining your medical records. This section includes details about allowable charges under state law for photocopies and related costs.
9. Print your name, sign the document, and date it. These signatures validate your authorization for the release of your health information.
10. Once you have filled out all sections accurately, save any changes, download the completed form, or print it for submission.

Complete your Form 6700 online today to efficiently manage your health information release.