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The document is an authorization form for the release and disclosure of medical information from Pine Rest Christian Mental Health Services. It allows the patient to authorize the release or request of their medical records, specifying the types of information to be disclosed and the purpose for sharing it. The form emphasizes patient consent, rights regarding revocation, and compliance with HIPAA and Michigan Mental Health Code regulations.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does Pinerest do?

Pine Rest is the third largest non-profit behavioral health provider in the U.S., offering a full continuum of services including psychiatric urgent care, inpatient and partial hospitalization, residential, outpatient and teletherapy services, addiction treatment and recovery, extensive child and adolescent programs,

Who owns Pine Rest?

Dr. Eastburg adds that both Corewell Health and Pine Rest Christian Mental Health Services are nonprofits owned by the community and, as such, share a responsibility to work together if collaboration will lead to better care for Michigan children, adults, and families.

What does signing a release do?

Once you sign a release agreement, you will be prevented from filing further claims for any injuries, whether known or unknown. Our veteran attorneys have witnessed far too many victims who do not realize the overall extent of their injuries before signing releases.

What does signing a release of information mean?

An ROI is a form authorizing doctors to share a patients files. Without a signed ROI, providers cannot legally disclose medical details, even if sharing could help. The ROI allows care team membersdoctors, nurses, specialiststo communicate about treatment. This ensures all involved are aligned for coordinated care.

What is the purpose of the authorization to release information?

A copy of your confidential medical records can be provided to your insurance or sent to an employer, another university, or continuing care provider after you sign a release of information form available from the Health and Wellness Center.

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Which is a reason to have a signed release of information form?

Generally, an authorization provides the authority for a doctors release of PHI for specified purposes, which are generally other than treatment, payment, or healthcare operations, or, to disclose protected health information to a third party specified by the individual.

How to write an authorization to release medical records?

I, the undersigned, authorize the release of, or request access to the information specified below from the medical record(s) of the above name patient. I understand that my records are confidential and cannot be disclosed without my written authorization, except when otherwise permitted by law.