OSU SHS Authorization for Release of Health Information 2020-2025 free printable template
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Student Health Services The Ohio State UniversityLast1875 Millikan Road, Columbus, OH 43210 Phone: 6142920118 Fax: 6142927042 Email: medical records OSU.eduFirstMIID# (Place patient label here)AUTHORIZATION
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How to fill out OSU SHS Authorization for Release of Health Information
How to fill out OSU SHS Authorization for Release of Health Information
01
Obtain the OSU SHS Authorization for Release of Health Information form from the relevant website or office.
02
Fill in your personal information such as full name, address, and student ID number.
03
Specify the type of health information you wish to be released.
04
Indicate the purpose for releasing this information.
05
Provide the name and contact information of the person or organization to whom the information should be sent.
06
Sign and date the form to authorize the release.
07
Submit the completed form to OSU SHS either in person or via the specified submission method.
Who needs OSU SHS Authorization for Release of Health Information?
01
Students seeking to share their health information with third parties, such as healthcare providers or insurance companies.
02
Any individual requiring access to a student's health records, such as a parent or guardian with student consent.
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What is OSU SHS Authorization for Release of Health Information?
OSU SHS Authorization for Release of Health Information is a formal document that allows the Student Health Services at Ohio State University to share a patient's medical information with designated individuals or entities.
Who is required to file OSU SHS Authorization for Release of Health Information?
Any student or patient who wishes to have their health information disclosed to a third party must file the OSU SHS Authorization for Release of Health Information.
How to fill out OSU SHS Authorization for Release of Health Information?
To fill out the OSU SHS Authorization for Release of Health Information, a patient must provide their personal information, specify the information to be released, identify the recipient of the information, and sign the form to authorize the release.
What is the purpose of OSU SHS Authorization for Release of Health Information?
The purpose of the OSU SHS Authorization for Release of Health Information is to ensure that sensitive medical information can be shared legally and ethically with the consent of the patient, facilitating better healthcare management.
What information must be reported on OSU SHS Authorization for Release of Health Information?
The OSU SHS Authorization for Release of Health Information must include the patient's name, date of birth, details of the information to be released, purpose of the release, recipient information, and the patient's signature and date.
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