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! Corvallis 673 NW Jackson Ave. Corvallis, OR 97330 Phone: (541) 2301630 Fax: 1(800) 7477137 Salem 528 Cottage St. NE Suite 320 Salem, OR 97301 Phone: (503) 3397355 Fax: 1(800) 7477137 Authorization

How to fill out releaseofinformation061414pages

How to fill out releaseofinformation061414pages:

1. Start by reading the instructions provided on the form carefully. Ensure that you understand the purpose of the release of information and the specific details required.
2. Begin by providing your personal information, such as your full name, address, phone number, and date of birth. This section helps to identify you as the individual authorizing the release of information.
3. Next, identify the organization or individual you are authorizing to release your information. Include their name, address, and any additional contact information if required.
4. Specify the types of information you are authorizing the release of. This can include medical records, educational records, employment records, or any other relevant information. Be specific about the time period or specific dates for which you are authorizing the release.
5. If there are any restrictions or limitations to the release of information, clearly indicate them in the appropriate section. This could include excluding certain medical conditions or specific documents.
6. Provide your signature and the date on the form to indicate your consent and authorization for the release of information.
7. Make a copy of the completed form for your records before submitting it to the organization or individual who requires the release.

Who needs releaseofinformation061414pages:

1. Individuals who are seeking medical treatment and need to authorize the release of their medical records to another healthcare provider or specialist.
2. Job applicants who are required to provide their previous employment records to potential employers.
3. Students who are transferring schools and need to authorize the release of their educational records to the new institution.
4. Individuals who are involved in legal proceedings and need to authorize the release of relevant documents or information to their legal counsel or opposing party.
5. Patients who want to grant access to their medical records to a family member or caregiver for healthcare purposes.
6. Individuals applying for government benefits or programs that require the release of specific information for eligibility determination.

Remember, the specific use and requirements for releaseofinformation061414pages may vary depending on the organization or situation, so it is essential to follow the instructions provided on the form and consult with the relevant parties if necessary.

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