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2018 Release of Information Form Master of Arts in Teaching Please read directions carefully before completing In accordance with the Family Educational Rights and Privacy Act (FER PA), the Health

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What is release of information form?

The release of information form is a document that allows individuals to authorize the disclosure of their protected health information to a specific person or entity.

Who is required to file release of information form?

Anyone who wants their protected health information to be shared with a specific person or entity is required to file a release of information form.

How to fill out release of information form?

To fill out a release of information form, you need to provide your personal information, specify who is authorized to receive your information, and sign and date the form.

What is the purpose of release of information form?

The purpose of the release of information form is to ensure that individuals have control over who can access their protected health information.

What information must be reported on release of information form?

The release of information form must include the individual's name, the name of the person or entity authorized to receive the information, the type of information to be disclosed, and the purpose of the disclosure.

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