Get Georgian Court University Hipaa Designation / Emergency Contact Form 2008-2025

Filling out the Georgian Court University HIPAA Designation / Emergency Contact Form online is an essential step in ensuring that your health information is appropriately managed during emergencies. This guide will walk you through the process in a clear and supportive manner, assisting you in providing the necessary information responsibly.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the document and open it in your preferred editor.
2. Begin by reviewing the information provided in the first section regarding the use and disclosure of Protected Health Information. Familiarize yourself with how your information will be shared with the GCU Student-Athlete Medical Team.
3. In the signature area, confirm that you have read and understood the above information by providing your signature and the date.
4. Print your name clearly in the designated field. If you are under the age of 18, be sure to have a parent or guardian sign in the appropriate section.
5. Proceed to fill out the emergency contact sections by entering the names, relationships, and contact information for up to three emergency contacts.
6. For each emergency contact, indicate whether you authorize the disclosure of your Protected Health Information to them by checking the respective box.
7. After completing the contact information, confirm your understanding regarding the expiration of the authorization and the process for withdrawing consent.
8. Final steps: Once all required fields are filled out, you can save any changes, download the completed form for your records, print a copy if needed, or share it as instructed.

Start filling out your Georgian Court University HIPAA Designation / Emergency Contact Form online today to ensure your health information is secure.