Authorization to disclose healthcare information - Harbor Oaks 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Patient Full Name, Date of Birth, Phone Number, and Address in the designated fields. Ensure all information is accurate to avoid processing delays.
3. In the section labeled 'I hereby authorize', select whether you want to release or exchange information by checking the appropriate box.
4. Fill in the name and relationship of the recipient (Carolina House) along with their address and contact details. This ensures that your information reaches the correct party.
5. Indicate which specific information you wish to disclose by checking the relevant boxes under 'The following information is requested'. Be thorough in your selections.
6. Specify the purpose for disclosure from the provided options. This helps clarify why this information is being shared.
7. If applicable, indicate if you consent to release sensitive health records by checking 'Yes' or 'No' next to each category.
8. Choose your preferred disclosure format (e.g., email or fax) if different from default options.
9. Finally, sign and date the form at the bottom. Ensure that all sections are completed before submission to prevent delays.

Start using our platform today for free and streamline your document management process!