Get Mn Hennepin Healthcare Authorization To Release Health Information 2020-2025

Filling out the MN Hennepin Healthcare Authorization To Release Health Information form is an essential step for ensuring your health information is shared with the appropriate parties. This guide provides clear instructions to help users complete the form effectively and securely online.

Follow the steps to complete your authorization form successfully.

1. Press the ‘Get Form’ button to access the authorization form and open it in the designated editor.
2. Provide your patient information by entering your full legal name, date of birth, maiden name or any aliases, social security number, and phone number into the relevant fields.
3. In the 'Health Information Released FROM' section, select one option. If you choose Hennepin Healthcare System, this includes all clinics, emergency room, and hospital records unless specified otherwise.
4. In the 'Health Information Released TO' field, enter the complete name and address of the person or organization that will receive the information, including the city, state, and fax number if applicable.
5. Indicate the health information to be released by specifying the relevant dates of service and types of visits. Select from the list or write 'Other' if necessary, detailing the specific health information you wish to share.
6. Decide whether sensitive information such as alcohol/drug use, mental health, or HIV/AIDS records should be disclosed. Initial each applicable line to indicate your preferences.
7. Select the form or format for release. Choose from hard copies, electronic copies, verbal exchange, or review of record.
8. Fill in the purpose of the release by checking an appropriate box or writing in your specific reason. If applicable, include any related appointment dates.
9. Select how you would like the records delivered: mail, fax, or email. Ensure that you provide complete address information according to your choice.
10. Read through the Authorization/Revocation section, which indicates the authorization lasts for one year unless another specified term is indicated. Ensure to sign and date this section.
11. Verify any potential charges for the records and review the form to confirm all information is correct and complete.
12. Finally, save your changes, and decide whether to download, print, or share the completed form online.

Complete your authorization form online today for a smooth and secure release of your health information.