Get Review Of Records Agreement (ipr-4) - Oasas - New York State

Filling out the Review Of Records Agreement (ipr-4) is a crucial step for individuals conducting an independent peer review involving sensitive medical and treatment records. This guide will take you through the process step-by-step to ensure clarity and compliance with confidentiality regulations.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Review Of Records Agreement (ipr-4). This will open the document for you in an editable format.
2. In the first section, you are required to enter your name in the space provided for the 'Name of Reviewer'. Ensure it is clearly indicated as you will be identified as the reviewer.
3. Below your name, specify the program you are reviewing in the section labeled 'Name of Program Being Reviewed'. Make sure to include the full and accurate name to avoid any confusion during the review process.
4. Next, read the confidentiality agreement carefully. You must acknowledge that you will not re-disclose any patient-identifying information and will use the information solely for the peer review process.
5. Sign your name in the designated area as the 'Signature of Reviewer'. This signature confirms your agreement to the terms outlined in the document.
6. Print your name again in the field labeled 'Print Name of Reviewer'. This helps to clarify the identity of the reviewer associated with the signature.
7. Complete the section for 'Name of Organization' by inputting the organization you are affiliated with, ensuring it aligns with the peer review purpose.
8. Fill in your title in the respective field titled 'Title'. This provides context about your professional capacity in relation to the review.
9. Finally, record the date when you are completing the form in the field marked 'Date'. This is essential for a clear timeline of the review process.
10. Once you have completed all necessary fields, you may save your changes, download the document for your records, print a hard copy if necessary, or share it as directed.

Complete your Review Of Records Agreement (ipr-4) online today to ensure a smooth and efficient review process.