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This document provides consent for Emory University to disclose personally identifiable information contained in student health records. It outlines the student’s authorization for sharing health-related information with specified offices and entities, under the protections of the Family Educational Rights and Privacy Act (FERPA). The form includes options for what information can be shared and with whom, as well as the purposes for sharing that information.
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How to fill out consent to disclose personally

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How to fill out consent to disclose personally

01
Obtain a consent form from the relevant agency or organization.
02
Clearly indicate the individual's name and contact information at the top of the form.
03
Specify the type of information that will be disclosed.
04
List the parties to whom the information will be disclosed.
05
Include the purpose of the disclosure.
06
Ensure that the individual signs and dates the form to confirm consent.
07
Retain a copy of the signed consent for records.

Who needs consent to disclose personally?

01
Healthcare providers seeking to share medical information.
02
Employers needing to verify background checks.
03
Educational institutions requiring academic records disclosure.
04
Financial institutions requesting personal financial details.
05
Any organization or individual who handles sensitive personal information.
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Consent to disclose personally refers to an individual’s permission for their personal information to be shared with specified entities or individuals.
Individuals or organizations that need to share personal information about an individual typically must file consent to disclose personally.
To fill out consent to disclose personally, one must provide the necessary personal information, specify who the information will be shared with, and provide a signature to indicate approval.
The purpose of consent to disclose personally is to protect individual privacy by ensuring that personal information is only shared with permission.
Information that must be reported typically includes the individual's name, the type of information to be disclosed, the purpose of the disclosure, and the names of the parties involved.
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Relevant keywords

Emory University student health records FERPA health information consent personally identifiable information case management coordination of care psychological services treatment summary health privacy

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