Get Oh C-101 2020-2025

The OH C-101 form, known as the Authorization to Release Medical Information, is essential for injured workers seeking to authorize the release of their medical records related to work-related injuries. This guide will walk you through the process of completing this form online, ensuring you provide all necessary information accurately.

Follow the steps to complete the OH C-101 online.

1. Press the ‘Get Form’ button to obtain the OH C-101 form and open it in the editor.
2. Begin by filling in your personal information, including your name (first, middle initial, last), address, and nine-digit ZIP code. Ensure that this information is accurate to avoid any processing delays.
3. Next, enter the date of your injury and the name of your employer. It is important to provide the correct claim number associated with your workers' compensation claim.
4. List the managed care organization (MCO) or qualified health plan (QHP) associated with your employer. This information helps streamline the communication between the relevant parties.
5. In the designated area, authorize specific providers by listing their names. This can include individuals or facilities that have provided medical services related to your injury.
6. Review the detailed list of medical, psychological, and/or psychiatric information you are authorizing for release. Ensure that all relevant information is included, as outlined in the guide.
7. Sign and date the form in the appropriate fields. If someone is signing on your behalf, they must indicate their authority to do so and provide their name.
8. Finally, save your changes. You can choose to download, print, or share the completed form with the necessary parties, including the customer service office where your claim is located or your self-insured employer.

Complete your OH C-101 authorization form online today to ensure timely processing of your workers' compensation claim.