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MICHELLE GRAVES SHERMAN, MD, LLC Child, Adolescent & Adult Psychiatry 5454 Wisconsin Avenue Suite 1275 Chevy Chase, MD 20815 Tel: 301.656.1770 Fax: 240.396.5901 RELEASE OF INFORMATION I, /We, hereby
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01
Identify the purpose of the release of information.
02
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03
Provide personal and contact information of the person releasing the information.
04
Specify the recipient of the information.
05
Describe the type and scope of the information to be released.
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07
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Submit the completed form to the appropriate person or organization.
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01
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What is release of information?
Release of information is a process that allows the transfer of confidential information from one party to another with the consent of the individual or entity the information pertains to.
Who is required to file release of information?
Healthcare providers, insurance companies, employers, and other entities handling sensitive information are required to file release of information.
How to fill out release of information?
To fill out a release of information form, provide your personal details, specify the information to be released, indicate who the information is being released to, and sign the form to authorize the release.
What is the purpose of release of information?
The purpose of release of information is to ensure that confidential information is shared appropriately and with the consent of the individual or entity it pertains to.
What information must be reported on release of information?
The information that must be reported on release of information includes personal details of the individual, the specific information being released, the purpose of the release, and any restrictions on the use of the information.
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