Get Identity Theft Protection Questions - Ttuhsc

Filling out the Identity Theft Protection Questions form is an essential step in protecting your personal information and ensuring your privacy within the Texas Tech University Health Sciences Center. This guide will help you understand how to complete this form accurately and efficiently online.

Follow the steps to complete the Identity Theft Protection Questions form

1. Click ‘Get Form’ button to obtain the Identity Theft Protection Questions form and open it in your preferred form editor.
2. Begin by entering your patient name and medical record number (MRN) at the top of the form. Ensure this information is accurate to prevent any issues with your request.
3. Fill in your date of birth (DOB). Providing your DOB helps verify your identity and is a standard requirement for medical forms.
4. In the section titled 'Permission to give verbal protected health information or leave messages', list the names and relationships of individuals whom you authorize to receive information on your behalf. Include their phone numbers for contact.
5. Next, provide the phone numbers where you allow messages to be left without disclosing specific protected health information. Limit this to numbers you frequently check.
6. If you wish to receive information regarding the online patient portal and general updates via email, indicate your email address in the specified field.
7. Proceed to the 'Security and Identity Theft Protection Questions' section. You are required to provide answers to at least two of the security questions provided. Choose questions that you can easily remember the answers to.
8. At the bottom of the form, specify the date, print your name, and provide your signature. Ensure that the signature is from the patient or a legally authorized person.
9. Finally, include the time of signing, and if necessary, fill in the witness or translator details and their relationship to the patient.
10. Once all fields are completed and reviewed for accuracy, save your changes, and download or print the form as necessary for your records.

Complete the Identity Theft Protection Questions form online to enhance your privacy today.