Get Henry Ford 26091 2021-2026

This guide provides clear and supportive instructions for completing the Henry Ford 26091 form online. The form is essential for authorizing access to or the release of your medical information, ensuring that your preferences are clearly communicated.

Follow the steps to fill out the Henry Ford 26091 form online

1. Press the ‘Get Form’ button to obtain the Henry Ford 26091 form. This will allow you to open the document for editing.
2. Begin by entering your personal information in the designated fields. This includes your full name, any previous names (if applicable), current address, date of birth, city, phone number, state, zip code, and e-mail address (if applicable). Ensure all details are accurate.
3. Authorize the release of your medical records by selecting the Henry Ford Health System facility from which you want your records sent. Check all applicable boxes, including the specific organization.
4. Indicate to whom you are authorizing your records to be released by selecting the appropriate options for yourself or other individuals/organizations. Complete all fields required for your selected option, providing addresses and other necessary contact information.
5. If you want to include sensitive medical records, check the appropriate boxes for substance use disorder or psychotherapy notes, and identify the purpose of the request. Complete the specific information requested section regarding the type of records.
6. Read the authorization statement thoroughly, acknowledging the conditions of the release. Sign and date the document, indicating your relationship to the patient if you are signing on their behalf.
7. After completing the form, you have the option to save your changes, download the document, print it, or share it as required. Ensure you follow the instructions for submission, either by mailing, faxing, or other methods as indicated in the form.

Complete your documents online efficiently and manage your medical information access with ease.