Siu form 2026

1. Click ‘Get Form’ to open the siu form in the editor.
2. Begin by entering your Patient Information. Fill in your name, Dawg Tag#, local phone number, and date of birth in the designated fields.
3. In the authorization section, select whether you wish to release, obtain, or exchange protected health information by checking the appropriate box.
4. Provide details about the agency, facility, or person involved by filling in their name and address. Include their phone and fax numbers if applicable.
5. Indicate which records you want released by initialing next to each type of record listed. Be sure to note any sensitive information categories that you wish to exclude.
6. Specify the purpose of the release from the options provided and fill in any additional details as necessary.
7. Enter the date range for the records you are requesting and choose your preferred method of delivery for receiving these records.
8. Complete the authorization validity period by providing a date and ensure all required signatures are included at the bottom of the form.

Start using our platform today for free to streamline your siu form completion!