Get Authorization For Release Of Medical Information ... - Iowa Ortho

Filling out the Authorization for Release of Medical Information form is a crucial step in managing your healthcare information. This guide provides comprehensive, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the authorization form.

1. Press the ‘Get Form’ button to obtain the form and open it in your document management system.
2. In the 'Patient Information' section, enter your legal name, date of birth, address, city, state, zip code, phone number, and email address. Ensure all details are accurate to avoid processing delays.
3. For 'Who will receive your information?', fill in the receiving entity's name along with their address, city, state, zip code, phone number, and fax number, if available.
4. In the 'Who will send your information?' section, provide the name and address of the provider or facility releasing your information, along with their contact details.
5. Specify the 'Information to be sent' by indicating the service dates and selecting the relevant options such as entire record, laboratory reports, CD of images, or other specific requests.
6. Indicate the purpose for the release of information, such as legal needs, second opinion, or other specified purposes in the provided fields.
7. Choose your preferred format for receiving the information, either as electronic, printed copy, or on CD. Mark your choice clearly.
8. Submit the completed form by emailing it to the provided email address, faxing it, or returning it to any Iowa Ortho location. Alternatively, you may provide verbal authorization by calling the specified phone number.
9. Be aware of the authorization expiration date. Fill in the date or note that the authorization will expire in 365 days if no date is specified.
10. Lastly, sign and date the form, indicating your relationship to the patient if applicable. Review the details before final submission.

Take action today by completing your authorization form online.