Get Siu Release Of Information Form 2016

Filling out the SIU Release Of Information Form online can be a straightforward process when you know what to expect. This guide provides a clear, step-by-step explanation of each section of the form, tailored to your needs.

Follow the steps to successfully complete the SIU Release Of Information Form.

1. Press the ‘Get Form’ button to access the SIU Release Of Information Form and open it in your preferred editor.
2. Begin by entering your full name in the 'Patient Name' field. Ensure that the information matches your legal documents.
3. In the 'Release From' section, indicate the entity or individual you wish to release information from. You can select SIUC Student Health Services or provide an alternative source.
4. Specify the purpose for which the information is being released by checking the appropriate box, such as 'Patient’s Request', 'Legal', or 'Further Treatment'.
5. Indicate the dates of records that you wish to be released. Clearly state the timeframe to help ensure relevant records are provided.
6. Select how you wish the information to be released (written, verbal, or both). Make sure to check only the applicable options.
7. If the release includes sensitive information, initial the specific areas to confirm your understanding and consent. This includes sections related to HIV, mental health, and drug/alcohol records.
8. Choose your preferred method of delivery for the released information - by mail, hand carry, or fax. Ensure that your contact information is up to date for effective communication.
9. Review your patient rights section to confirm your understanding of your rights regarding this authorization. Note any details on revocation and legal liability.
10. Once you have completed the form, review all of your entries for accuracy. Finally, save your changes, download, print, or share the form as needed.

Complete your SIU Release Of Information Form online today to ensure your information is managed efficiently.