Health Records Release Authorization - The Ohio State 2026

1. Click ‘Get Form’ to open the Health Records Release Authorization in the editor.
2. Begin by filling out the Patient Information section. Clearly print your full name, date of birth, and preferred phone number to ensure accurate identification.
3. In the Receiving Party section, specify whether you want OSU Student Health Services to release or obtain information. Provide the recipient's name, address, and contact details.
4. Select the types of information you wish to be released from the provided options. Be specific about your needs for clarity.
5. Indicate the date range for which you are requesting information. Remember, future dates cannot be included.
6. Choose your preferred method of release (mail, fax, email, etc.) and ensure all necessary contact details are filled in.
7. Finally, review your entries for completeness and accuracy before signing and dating the form at the bottom.

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