Get Forms - Hawaii State Department Of Health

Filling out the forms from the Hawaii State Department of Health is an essential step for individuals and organizations in managing protected health information. This guide will provide clear and step-by-step instructions to ensure a seamless online completion of the necessary forms.

Follow the steps to complete the forms with ease.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. Provide the name and address of the individual or organization disclosing protected health information. This section identifies the source of the information.
3. Enter the physician’s name and address, including their phone and fax number, if applicable. This information will be necessary for communication during the disclosure process.
4. Fill in the details for the individual or organization that will receive the individual's protected health information, including their name and address.
5. Complete the section for the individual whose protected health information is being requested. This includes entering their first name, last name, address, and birth date if known.
6. Indicate the specific protected health information to be used or disclosed. Be thorough and clear in the description of the information, ensuring all limits are identified.
7. Mark the purposes for which the protected health information is being used or disclosed. You may check multiple options that apply to your situation.
8. Specify the authorization duration by entering an expiration date or related event. This determines the validity of the authorization for the use or disclosure.
9. Review the authorization statement regarding rights to revoke and understand the implications of the use or disclosure of your information.
10. Sign the form by providing the signature of the individual or personal representative, along with the date and name of the personal representative.
11. Finally, save your changes, and consider options to download, print or share the completed form as needed.

Complete your necessary documents online to ensure a smooth process.