Get Az Touchstone Health Services Authorization For Release Of Information 2019-2025

Filling out the AZ Touchstone Health Services Authorization For Release Of Information form is a crucial process for authorizing the release of your health information. This guide provides a clear, step-by-step approach to ensure you complete the form correctly and efficiently online.

Follow the steps to accurately complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Print clearly in all fields starting with the member's name, CIS number, AHCCCS number, and date of birth.
3. Specify the person or agency authorized to disclose information, which for this form is Touchstone Health Services, including the provided address.
4. Identify the person or agency that will receive the information. Fill in their name, phone number, complete address, email, and fax number where applicable.
5. Select the preferred method of release by checking the appropriate box: Mail, Pick-Up, Fax, or Email.
6. Indicate the information to be disclosed by marking the items that apply, including assessments, treatment plans, test results, and billing statements.
7. Specify any other important information to include as needed.
8. Complete the dates of the records to be released. If no dates are mentioned, records for the last two years will be provided.
9. Mark the checkbox if you allow the mentioned parties to disclose information to each other.
10. State the purpose for disclosure in the designated area, explaining why you are requesting this authorization.
11. Understand your rights regarding this authorization and initial where specified, confirming your awareness of revocation policies.
12. Sign and date the document in the provided fields, and include any other required signatures if applicable.
13. Finally, save your changes, download, print, or share the completed form according to your needs.

Complete your AZ Touchstone Health Services Authorization For Release Of Information online today to ensure timely management of your health information.