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Authorization to Communicate Release of InformationMRN: ID checked by:A. Patient Information Name (First MI Last): DOB: SSN *****___ Address: Phone: City: State: ZIP: Maiden/Prior Name: Email: C#B.
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How to fill out uhs him roi authorization

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How to fill out uhs him roi authorization

01
Obtain the UHS HIM ROI authorization form.
02
Fill out your personal information, including your name, date of birth, address, and contact information.
03
Specify the information you are requesting to be released and the purpose of the release.
04
Sign and date the form to authorize the release of your health information.
05
Submit the completed form to the UHS HIM department for processing.

Who needs uhs him roi authorization?

01
Anyone who wishes to request the release of their health information from UHS HIM department.

What is UHS HIM ROI Authorization . ... Form?

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UHS HIM ROI Authorization refers to the legal document that allows a specific individual or organization to access health information from a patient's medical records for specific purposes.
Typically, healthcare providers, patients, or authorized representatives who seek access to health information need to file UHS HIM ROI Authorization.
To fill out UHS HIM ROI Authorization, individuals must provide their personal information, specify the information they are requesting, outline the purpose of the request, and sign the document to authorize the release.
The purpose of UHS HIM ROI Authorization is to ensure that patients have control over their health information and that it is shared only with their consent for specific reasons.
The UHS HIM ROI Authorization must include the patient's name, date of birth, type of information requested, purpose of the request, and the authorized individual's signature.
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