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Revised 01/11, 4/18RELEASE OF INFORMATION
This information will be released upon subpoena or direction from the court.
Personal information will be removed prior to releasing.
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What is release of information?
Release of information is a process where an individual authorizes the disclosure of their personal health information to a third party.
Who is required to file release of information?
Healthcare providers, insurance companies, and other entities that handle personal health information are required to file release of information when requested by the individual or authorized representative.
How to fill out release of information?
To fill out release of information, the individual must complete a form provided by the healthcare provider, insurance company, or entity handling their personal health information. The form typically requires the individual's identifying information, the information to be disclosed, and the purpose of the disclosure.
What is the purpose of release of information?
The purpose of release of information is to ensure that personal health information is disclosed in a secure and confidential manner, while still allowing individuals the ability to share their information with authorized parties for healthcare, insurance, or legal reasons.
What information must be reported on release of information?
The release of information form typically requires the individual's identifying information, the specific information to be disclosed, the purpose of the disclosure, and any restrictions on the disclosure.
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