Follow the steps to complete the HI CARES Network Consent Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the individual’s first name and last name in the designated fields. Ensure the names are spelled correctly as they will be used for identification purposes.
3. Fill out the address field with the complete residential address of the individual whose Protected Health Information is being disclosed.
4. Input the date of birth of the individual in the specified format.
5. Check the box authorizing the disclosure of Protected Health Information to all parties within the CARES provider network for the purpose of care coordination and treatment services.
6. Select the type of Protected Health Information that will be disclosed by checking the appropriate boxes. You may choose all health information or specify other relevant information.
7. Initial in the provided spaces to agree to the terms of the disclosure.
8. Indicate the purpose of the information disclosure, as described in the form, and confirm your understanding of the rights involved regarding revocation of this authorization.
9. Sign and date the form at the designated area to validate your consent.
10. Print your name and detail any authority as a personal representative if applicable.
11. Finally, save your changes, and choose to download, print, or share the form as needed.

Complete the HI CARES Network Consent Form online today to start accessing the services you need.