Get Csmo Authorization For Use And Disclosure Of Protected Health Information

Filling out the CSMO Authorization For Use And Disclosure Of Protected Health Information form is an essential step for individuals seeking access to their medical records. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the appropriate box for your request. Choose between 'For Medical Records Copies' or 'For Forms Processing' based on your needs.
3. Enter your personal information in the required fields, including your name, phone number, date of birth, and address.
4. Specify the dates of service for which you are requesting records. Fill in the fields labeled 'From' and 'To'.
5. Indicate the specific provider at the Center for Sports Medicine from whom you are requesting records.
6. Provide a detailed description of the information you are requesting, such as office notes, imaging reports, or lab reports.
7. Enter your personal email address in the required field for electronic delivery.
8. State the reason for your request in the designated field.
9. If you wish to release requested records to another person or entity, fill out the relevant section, including their name, address, and fax number.
10. Review your completed form to ensure all information is accurate and fully filled out.
11. Sign and date the form to authorize the release of your protected health information.
12. Save your changes, then download, print, or share the completed form as needed.

Complete your documents online today to ensure access to your medical records.