Get Nyu Hospitals Center Authorization To Release Protected Health

Completing the NYU Hospitals Center Authorization To Release Protected Health form is a vital step in managing your medical records. This guide intends to provide straightforward instructions to ensure you can easily understand and complete the form online.

Follow the steps to complete the authorization form accurately.

1. Begin by pressing the ‘Get Form’ button to access the authorization form. This will open the form in your preferred online document editor.
2. In the form, fill out your personal information in the designated fields. This includes your name, sex, birth date, address, and phone number. Ensure all fields are completed accurately.
3. Authorize the release of your protected health information by checking the appropriate boxes. You may specify if you, or your personal representative, are approving this authorization.
4. If applicable, indicate any specific health information categories you wish to disclose, such as alcohol/drug treatment or mental health treatment, by placing your initials in the corresponding spaces.
5. Identify the purpose for releasing your information. This can be for your own request or for continuity of care. Provide any additional information where required.
6. Specify the person or entity receiving the information, providing their name and address in the appropriate sections. If you plan to pick up the information personally, mention this as well.
7. Indicate the specific dates of service for which you are requesting information. Choose whether you want an abstract of pertinent information or your entire medical record.
8. Decide on the duration of this authorization, either for a one-time request or a specific event or date. Complete that section as necessary.
9. Review the entire form thoroughly. Once you are satisfied, sign and date the form, including any additional required information about your personal representative if applicable.
10. Finally, save your changes, then download, print, or share the completed form as needed.

Take the next step towards managing your health information by completing the form online.