Get Sc Dhhs Form 921 2016-2026

This guide provides a clear and supportive approach to completing the SC DHHS Form 921 online. It outlines the necessary steps to ensure that users can effectively and accurately fill out the form for authorization to disclose health information.

Follow the steps to successfully complete the SC DHHS Form 921 online.

1. Press the ‘Get Form’ button to retrieve the SC DHHS Form 921 and open it in your preferred editor.
2. Begin filling out the applicant's personal information. Enter the first name, middle name, last name, social security number, and date of birth. Also, include the household number or application ID if applicable.
3. In the section labeled 'WHAT,' specify the details of the medical records, education records, and other information requested for disclosure. Ensure that all items reflect the information pertinent to the individual's capability to perform daily tasks.
4. Identify the sources you are authorizing to disclose information by completing the 'FROM WHOM' section. Include all relevant medical and educational sources that hold information about the applicant.
5. In the 'TO WHOM' section, indicate that the information is to be shared with the state agency processing the case, typically referred to as SCVRD.
6. Fill in the 'PURPOSE' section to establish the intention behind gathering this health information, specifically for determining eligibility for Medicaid benefits.
7. Review the 'EXPIRES WHEN' section to note that the authorization is valid for 12 months from the signing date.
8. Sign the application as the applicant, or have the parent/guardian sign if the applicant is under 18. Include the relationship to the applicant and the date of signing.
9. If applicable, have a legal representative sign the document and attach any necessary Power of Attorney or legal guardian documentation.
10. Lastly, save the completed form to your device. You may now download, print, or share the form as needed.

Start filling out the SC DHHS Form 921 online today to ensure a smooth process in managing your health information.