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C O R D O G A N, C L A R K & A S S O C I A T E S, I N C. A r c h i t e c t SE n g i n e rs ARCHITECTS ADDENDUM NUMBER: 001 DATE: 03202017RE: Kane County2017 Mechanical Improvements ProjectPREPARED

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How to fill out c o r d

01

To fill out CORD (Consent for Release of Confidential Health Information) form, follow these steps:

02

Obtain a copy of the CORD form from the appropriate healthcare provider or organization.

03

Read the instructions and familiarize yourself with the purpose and use of the CORD form.

04

Provide your personal information, including your full name, address, date of birth, and contact details, as requested on the form.

05

Identify the healthcare providers or organizations that you authorize to release your confidential health information.

06

Specify the types of health information that you authorize to be disclosed by checking the appropriate boxes on the form.

07

Indicate the duration of the consent by specifying the start and end dates for the authorized disclosure.

08

Sign and date the CORD form to validate your consent.

09

Return the completed CORD form to the healthcare provider or organization as instructed.

10

Keep a copy of the signed CORD form for your records.

11

Note: It is important to understand the implications and potential risks associated with the release of confidential health information before filling out the CORD form. If you have any concerns or questions, seek guidance from a healthcare professional or legal advisor.

Who needs c o r d?

01

A CORD form is typically needed by individuals who want to authorize the release of their confidential health information to specific healthcare providers or organizations. This may include:

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- Patients who are transferring their medical records from one healthcare provider to another.

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- Individuals who are participating in research studies or clinical trials and need to grant access to their health information for study purposes.

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- Legal representatives or family members who require access to a patient's medical records for care coordination or decision-making purposes.

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- Individuals who want to share their health information with a trusted third party, such as an insurance company or an attorney.

06

It is important to note that the specific requirements and purposes for using a CORD form may vary depending on the jurisdiction and healthcare provider. Therefore, it is advisable to consult with the relevant healthcare provider or legal professionals to determine if a CORD form is appropriate in your situation.

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What is c o r d?

CORD stands for the Comprehensive Online Reporting Database, a platform used for submitting various compliance-related reports.

Who is required to file c o r d?

Entities that are subject to regulatory compliance standards or that have specific reporting obligations are required to file CORD.

How to fill out c o r d?

To fill out CORD, users need to access the online portal, complete all relevant fields with accurate information, and submit the form electronically.

What is the purpose of c o r d?

The purpose of CORD is to provide a centralized system for tracking compliance reports, ensuring transparency and accountability in regulatory frameworks.

What information must be reported on c o r d?

Information that must be reported includes entity identification details, compliance status, regulatory obligations, and any relevant documentation.

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