Get Omsi 581 2012-2025

The OMSI 581 is a vital form used to authorize the release of an individual’s health information. Completing this online form correctly ensures that your medical records are securely shared with authorized individuals or organizations.

Follow the steps to complete the OMSI 581 online effectively.

1. Click ‘Get Form’ button to obtain the OMSI 581 and open it for online completion.
2. Begin by filling in the patient’s name, Social Security number, date of birth, telephone number, and address at the top of the form.
3. In the authorization section, indicate how the health information should be sent by selecting options such as Mail, eDelivery (Personal Requests Only), or Other.
4. If the health information is required for a doctor’s appointment, make sure to specify the date needed.
5. Next, list the individual or organization authorized to make the disclosure, including the physician's name, clinic address, phone number, and relevant dates of service.
6. Specify the type of information you wish to be disclosed by selecting options for electronic delivery, paper copies of medical records, or specifying other needs.
7. Acknowledge your understanding regarding the contents of your health record. This may include sensitive health information, if applicable.
8. Indicate to whom the health information will be released, including their contact information.
9. State the purpose of the information release clearly.
10. Review the expiration condition of the authorization, ensuring to specify a date, event, or write ‘90 days’ if no specific condition exists.
11. Finally, provide your signature, the date, and, if applicable, sign on behalf of an authorized representative, ensuring to include their details.
12. Once all sections are completed, save your changes, and opt to download, print, or share the completed form as needed.

Start completing your OMSI 581 online today to ensure proper management of your health information.