Sd county tbs form 2025

1. Click ‘Get Form’ to open the sd county tbs form in the editor.
2. Begin by filling in the patient’s first name, last name, and middle initial. Ensure accuracy as this information is crucial for identification.
3. Enter the patient's address, including city, state, and zip code. This helps in verifying the patient's location.
4. Provide the telephone number and social security number (SSN) of the patient. This information is necessary for contact and identification purposes.
5. Fill in the date of birth and any known aliases (AKA's) to further clarify the identity of the individual.
6. In the section for authorized disclosure, input details about the organization making the disclosure—specifically 'County of San Diego' along with their address and contact information.
7. Select which specific health information you are authorizing for disclosure by checking the appropriate boxes provided on the form.
8. Finally, sign and date at the bottom of the form. If signed by a legal representative, include their relationship to the individual.

Start using our platform today to easily fill out your sd county tbs form online for free!