Get Sgf Authorization For Release Of Medical Information (phi) 2017

Filling out the SGF Authorization For Release Of Medical Information (PHI) is an essential process for patients needing to grant access to their health records. This guide will walk you through each step of the form, ensuring you complete it accurately and efficiently.

Follow the steps to complete your authorization form online.

1. Click ‘Get Form’ button to obtain the SGF Authorization For Release Of Medical Information (PHI) and open it in your online editor.
2. In the first field, enter the patient's full name as it appears on their medical records.
3. Provide the patient’s street address, ensuring all information is accurate to facilitate proper communication.
4. Fill in the city, state, and ZIP code for the patient’s address.
5. Enter the patient’s date of birth in the format of month, day, and year.
6. Complete the social security number field. This will be used to verify the patient's identity.
7. Add a daytime contact phone number where the patient can be reached.
8. Under the authorization statement, fill in the name of the person who is authorizing the release of information.
9. Specify the date range for the records being requested by filling in the start and end dates.
10. Select the types of medical records you wish to release by checking the corresponding boxes.
11. Indicate whether or not you authorize the release of HIPAA protected information related to sensitive topics by initialing the appropriate box.
12. In the 'Information Release To' section, fill in the name of the company, agent, facility, or person receiving the records.
13. Provide the street address, city, state, and ZIP code for the recipient.
14. If the records are to be sent via email to the patient, include the email address in the designated field. Remember, records can only be mailed to a physician’s office unless specified otherwise.
15. Specify the purpose of disclosure in the provided space to inform the recipient of the reason for the records request.
16. Sign and date the form at the bottom, ensuring that you have the authority to grant this authorization.
17. Review the completed form for accuracy, then save your changes. You can download, print, or share the form as needed.

Complete your SGF Authorization For Release Of Medical Information (PHI) online today to manage your health records efficiently.