Get Authorization To Communicate Information

This guide provides clear, step-by-step instructions for completing the Authorization To Communicate Information form online. By following these instructions, you will be able to authorize the release of important information regarding your care with ease.

Follow the steps to complete the Authorization To Communicate Information form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering your name in the designated field labeled 'Name'. This information is necessary to identify you as the patient.
3. Enter your date of birth in the 'DOB' field to further confirm your identity.
4. Fill in the current date in the 'Date' section to indicate when you are completing the form.
5. Next, provide the names, addresses, phone numbers, fax numbers, and email addresses of the physicians you authorize to receive your medical information. Make sure to initial next to the authorization statement for each physician.
6. Indicate your preference for how information can be shared by initialing the appropriate sections regarding voicemail, fax, or email communication.
7. If you wish to authorize the release of information to other individuals, fill in their names in the designated fields and initial for each entry.
8. Sign the form in the 'Signature of Patient' section, indicating your consent. If you are signing on behalf of a minor, please specify your relationship to the patient.
9. Review all entered information carefully for accuracy and completeness.
10. Finally, save your changes, download, print, or share the completed form as needed.

Complete your Authorization To Communicate Information form online today for seamless communication about your care.