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RELEASE OF INFORMATION TO PLANNED PARENTHOOD MINNESOTA, NORTH DAKOTA, SOUTH DAKOTAPATIENT NAME:PATIENT # LASTFIRSTDATE OF BIRTH:MAIDEN/OTHER PHONE: MO/DAY/YEARNING PHONE: PP OK? Y OR NPP OK? Y OR
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01
Obtain a release of information form from the organization or individual you need to share your information with.
02
Carefully read the form and make sure you understand all the sections and requirements.
03
Fill out your personal information accurately, including your full name, date of birth, address, and contact details.
04
Specify the purpose for releasing your information and provide details about the organization or individual who will receive it.
05
Clearly state the type of information you are authorizing to be released, such as medical records, educational records, or financial information.
06
Determine the duration of the release by specifying the start and end dates or indicating if it is ongoing.
07
Read any additional terms and conditions or special instructions provided on the form.
08
Sign and date the form to authorize the release of information.
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Keep a copy of the completed form for your records before submitting it to the appropriate recipient.

Who needs release of information to?

01
There are various situations in which someone might need a release of information form. Some common examples include:
02
- Patients who want to authorize the release of their medical records to another healthcare provider.
03
- Individuals applying for jobs that require background checks, where they may need to authorize the release of their educational or employment records.
04
- Students who need to grant access to their educational records for scholarship applications or transferring to another institution.
05
- Legal proceedings, where individuals may need to provide consent for the release of information relevant to a case.
06
- Insurance claims, where policyholders may need to authorize the release of their personal and medical information to the insurance company.
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Release of information is a process where a person authorizes the disclosure of their personal information to another party.
Any individual or organization that wants to share someone's personal information with a third party is required to file a release of information.
To fill out a release of information form, one must provide their personal information, specify the information they are authorizing to be released, and sign the form to authorize the disclosure.
The purpose of release of information is to ensure that personal information is shared only with authorized parties and in accordance with the individual's consent.
The release of information form typically requires the individual's name, contact information, details of the information being shared, and the name of the receiving party.
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