Fidelis forms 2026

1. Click ‘Get Form’ to open the fidelis form in the editor.
2. Begin by entering your name and Member ID in the designated fields at the top of the form.
3. Fill in your birthdate using the provided format (MM/DD/YYYY).
4. In the Authorization section, specify who you authorize to receive your health information by filling in their name.
5. Indicate whether this authorization covers a specific period or all past, present, and future periods by checking the appropriate box.
6. Select the extent of authorization by choosing either to release your complete health record or specifying exceptions for certain types of records.
7. Complete any additional sections regarding usage of information and expiration date for authorization.
8. Sign and print your name along with your relationship to the patient before submitting the form.

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