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RELEASE OF INFORMATION FORM Name of Student EMPLOY or SSN Program Location Session Code Term (This code can be found in the brochure or on our website at www.international.fsu.edu) Fall 2015 Spring
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How to fill out release of information 15-16
How to fill out release of information 15-16:
01
Start by obtaining the release of information form 15-16. This form is typically provided by the organization or institution that requires the release of information.
02
Fill in your personal information accurately and completely. This may include your full name, contact information, and any other identifying details requested on the form.
03
Specify the purpose of the release of information. Indicate why you are authorizing the release and what information you want to be disclosed. Be specific and clear in your wording.
04
Identify the recipient(s) of the information. Name the individuals, organizations, or institutions that you authorize to receive your information. Provide their contact details if required.
05
Set the duration of the release. Determine how long the authorization will be valid. You may choose to set an end date, specify a specific period (e.g., six months), or indicate that the release is ongoing until revoked.
06
Review and sign the form. Read through the entire document carefully to ensure accuracy and completeness. Sign and date the form in the designated areas.
07
Keep a copy of the completed release of information form for your records. This will serve as proof of your authorization and provide reference in case any issues arise.
Who needs release of information 15-16:
01
Patients requesting their medical records: Individuals who want to access their medical records from healthcare providers or hospitals often need to complete a release of information form 15-16. This allows the healthcare provider to disclose the requested medical information to the patient or a designated party.
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Insurance companies: Insurance companies may require a release of information form 15-16 to access a policyholder's medical records in order to process claims or determine coverage.
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Legal parties: Attorneys or legal representatives may need to obtain medical records for legal purposes, such as litigation or personal injury claims. They typically require a release of information form 15-16 signed by the client to access the necessary medical information.
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