Get Nc Carolina Spine & Neurosurgery Center Authorization For Disclosure Of Health Information 2011-2025

Navigating health information requests can feel overwhelming. This guide offers a clear step-by-step approach to filling out the NC Carolina Spine & Neurosurgery Center Authorization For Disclosure Of Health Information form online, ensuring that you can easily authorize the release of your medical records.

Follow the steps to complete your authorization form

1. Click ‘Get Form’ button to access the authorization form and open it in your online editor.
2. Begin by providing the patient's full name in the designated field. Be sure to enter their address, including street, city, state, and zip code, accurately.
3. Next, fill in the date of birth and the social security number of the patient. Complete the phone number field to ensure contact information is available.
4. Identify who the information will be sent to or received from. Fill out the name of the person or facility, their address, and phone number. Indicate whether the records will be sent by mail, picked up, or faxed.
5. Select the types of information you wish to release by checking the relevant boxes. This may include all office notes, hospital notes, physical therapy notes, or specific lab results.
6. Indicate if any sensitive information should be included or excluded, such as behavioral health records or HIV status, by checking or unchecking the corresponding options.
7. Specify the purpose of the disclosure by choosing from the options provided, including continued patient care or personal use.
8. Read through the authorization statement thoroughly. Sign and date the form at the bottom, ensuring that you also include your relationship to the patient if you are not the patient themselves.
9. Once all sections are completed, review the form for accuracy. You can then save your changes, download a copy for your records, print, or share the completed form as needed.

Complete your NC Carolina Spine & Neurosurgery Center Authorization For Disclosure Of Health Information online today and take charge of your health records.