Get Ma North Shore Pediatrics Authorization Of Release Of Information To Family Members/guardians

Filling out the MA North Shore Pediatrics Authorization Of Release Of Information To Family Members/Guardians form is essential for granting access to your protected health information. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete the authorization form online.

1. Click the ‘Get Form’ button to access the authorization form and open it in your preferred editing tool.
2. Enter the date on the form to indicate when you are completing the authorization.
3. In the designated space, write your full name to indicate who is granting permission.
4. Next, provide the name of the family member or guardian who will receive access to your health information.
5. Select the checkbox next to each option that you want to grant access for, including scheduling appointments, discussing information with the triage nurse, or accessing all medical records.
6. If you wish to deny access to any family member or guardian, select the checkbox that states you do not give permission for them to access your medical records.
7. Sign the form in the designated signature area to validate the authorization.
8. Once you have filled out all sections, review the information to ensure accuracy. You may then save changes, download, or print the completed form as needed.

Complete your authorization form online today to ensure your health information is shared as you intend.