Get Northwestern University The Family Institute Consent For Release Of Information 2007-2025

Filling out the Northwestern University The Family Institute Consent For Release Of Information form online can be a straightforward process when you have clear instructions. This guide will walk you through the necessary steps to complete the form accurately and efficiently.

Follow the steps to complete the consent form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the client's full name in the 'Client Name' field.
3. In the 'Birthdate' section, provide the date of birth in the specified format (mm/dd/yyyy).
4. Fill in the 'Street Address,' 'City,' 'State,' and 'Zip Code' fields with the client's current address.
5. Next, indicate whether you authorize The Family Institute to 'release to' or 'obtain from' by circling the appropriate option.
6. Provide the name, relationship, address, and phone number of the individual or agency involved in the consent.
7. Specify the records and information to be shared by initialing the boxes next to the corresponding categories, such as 'Discharge Summary' or 'Treatment Notes.'
8. Indicate the time period for which the records are applicable by filling in the start and end dates.
9. If applicable, authorize the re-disclosure of records by providing the names or agencies.
10. Clearly state the purpose of the consent, such as 'follow-up care' or 'treatment planning,' in the designated area.
11. Specify the expiration date of the consent. If left blank, it will be valid only for the date received.
12. Sign and date the form in the required sections, ensuring that a parent or guardian signs if the client is under 18.
13. Finally, include a witness signature in the designated area.
14. Once you have completed the form, you can save changes, download, print, or share it as necessary.

Take action now and complete your documents online for a smooth and efficient process.