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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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We protect your documents and personal data by following strict security and privacy standards.
Rule 5122-27-06 | Release of information. (A) Each request for information regarding a current or previous client shall be accompanied by an authorization for release of information, except as specified in sections 5119.27, 5119.28, and 5122.31 of the Revised Code.
Ohio Rev. Code Ann. § 5122.04 provides that a minor age 14 or older may consent for outpatient mental health services, excluding the use of medication, offered by a “mental health professional.” Services are limited to not more than 6 sessions or 30 days of services, whichever occurs sooner.
Code 3364-90-01. Health information that identifies an individual, or in respect of which there is a reasonable basis to believe that it can be used to identify, the individual is protected by law. Such information is confidential and may only be released in ance with the law.
In Ohio, the elements of an informed consent claim are: The physician failed to disclose the material risks and dangers involved in a proposed course of treatment (therapy, surgery, etc.); An unrevealed risk or danger actually materializes and causes injury to the patient; and.
Per Ohio Rev. Code §§ 2933.51, Ohio is a one-party consent state. This means that under Ohio law, only one person involved in a conversation needs to consent to its recording. If you participate in a conversation, you can legally record it without notifying the other party.
In Ohio, the elements of an informed consent claim are: The physician failed to disclose the material risks and dangers involved in a proposed course of treatment (therapy, surgery, etc.); An unrevealed risk or danger actually materializes and causes injury to the patient; and.
Ohio adheres to a “one-party consent” rule, meaning that as long as one party to the conversation (in this case, you, the patient) consents to the recording, it is permissible.
With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.
A written request signed by the patient or by what the law refers to, as a "personal representative or authorized person" is required. Ohio Revised Code §3701.74 obligates a physician to permit a patient or a patient's representative to examine a copy of all of the medical record.
Step 1: Fill out Authorization – Release of Information form. Step 2: Mail/fax/deliver the completed form to your HealthSource of Ohio location. Request fulfilled in approximately 3-7 days.