Get Ca Stanford Health Care Form 15-79-1 2015-2025

Completing the CA Stanford Health Care Form 15-79-1 online is a straightforward process. This guide will walk you through each section of the form to ensure you provide the necessary information accurately and clearly.

Follow the steps to complete the form with ease.

1. Click the ‘Get Form’ button to access and open the form in the online editor.
2. Begin by filling out Section A with the patient’s name (last and first), date of birth, and phone number. Make sure to also include the medical record number if available.
3. In Section B, indicate which facility or provider you authorize to disclose the information by checking the appropriate box. You may specify additional clinics by providing their name and address as required.
4. In Section C, describe the specific health information you would like released. Check and initial the boxes relevant to your request for general health information and any specific types of information such as mental health, HIV lab tests, or hereditary disorder results.
5. Select your preferred format for receiving the information in Section D. Options include paper copy, encrypted CD/DVD, or electronic PDF file.
6. Indicate the method for receiving the released information in Section D, choosing between mail, fax, in-person pick-up, or secure email. Ensure to provide the necessary contact details if opting for fax or email.
7. Fill in Section E with the reason for the release of your health information. If you are the patient, you may choose not to provide a reason.
8. In Section F, note the expiration date of the authorization, which will default to one year from the date of signing unless otherwise specified.
9. Review Section G carefully to understand your privacy rights related to this authorization.
10. Finally, in Section I, print your name and the name of any legal representative (if applicable), provide your relationship to the patient, and sign and date the form to complete the authorization.
11. Once completed, ensure you save changes. You can download, print, or share the form as needed.

Start filling out your CA Stanford Health Care Form 15-79-1 online today!