In the duration of a transaction for goods and services, the organization or the agency whom a client is transacting with will be recording the details of the transaction as well as the client’s information. These records will be kept by the organization for documentation purposes and for addressing future disputes or issues in lieu of the executed transaction. And if a client wants to have his information, or yet aims to send his information to another party, he must first fill out a general release of information form to start the process of the information release.

General Hospital Release of Information Form

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What Is a General Release of Information Form?

A general release of information form is to be used for documenting the approval of the data owner for other parties to obtain and use the information that he provided to an organization. The form is commonly used by medical and health care providers, as well as financial and educational institutions. In addition, the form must only be signed by the data owner, however, an authorized representative can also use the form yet he must prove that he is authorized by the data owner.

HIV Release of Information Form

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How to Create a General Release of Information Form

To create a general release of information form, the steps below must be followed:

Step 1: Set up the document sheet. The size of the margins for the document sheet must be set up along with other format styles.

Step 2: Add the name of the organization or company at the topmost portion of the form. The name of the organization should be emphasized and must be accompanied by the organization’s logo at the side. In addition, the address and the contact information of the organization can also be placed on the opposite side as well as their website and email addresses.

Step 3: State the title of the form and the instructions to be followed by the end-user. The title should specifically indicate the variety of general release of information form. Below the title must be the instructions or the step-by-step guide which will help any end-user in filling out the form and in completing the request procedure.

Step 4: Allocate a section for the basic information of the data owner. In this section, the data owner’s name, his record number, date of birth, residential address, and phone number must be collected. Moreover, the relationship of the end-user to the data owner should also be indicated in this section for those who wanted to request for the release on the data owner’s behalf.

Step 5: Incorporate a permission section. This will be the section for documenting the permission of the data owner to have his information be shared to the requesting party. The details to be stated in this section would be the name of the data owner and his contact information along with the type of delivery method to be used for sending the documents. Additionally, the name of the recipient or the requesting party with his address, fax number, and his purpose for requesting the document must also be indicated either for insurance purposes, for meeting legal requirements, or for personal reasons.

Release of Patient Health Information Form

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Step 6: Enlist the types of information or records that the organization has kept. Checkboxes must be placed beside each item on the list which will allow the end-user to indicate which among the documents will be released and be sent to the requesting party. In addition, confidential documents must only be obtained by a requesting party with the submission of specific forms such as a patient’s medical authorization for an HIV test result, or a student authorization for a student report.

Step 7: Include an agreement statement for the data owner. The agreement statement must focus on the approval and the agreement of the data owner towards the intent and the process of sending his forms to the requesting party. A signature block should be placed below the agreement statement for the signature of the data owner and the date when the general release of information form was completed.

Examples of General Release of Information Forms

Authorization to Release Information Form – In this variety of general release of information form, the end-user will have to fill out three sections for the release. Each section of the form contains paragraphs of statements and agreements intended to define the intents of the end-user. The first section centers on the release authorization and the re-disclosure of information wherein the type of document to be released and the expiration date of the authorization will be stated. The second section of the form, on the other hand, is for the consultation authorization which will indicate the approval of the end-user for a possible consultation process if the person requesting the document is a consultant, either a legal or a medical consultant. And lastly, the third section will be for the authorization to be provided by the end-user in releasing protected information to the requesting party.

Authorization to Release Information Form

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Consent to Release Information Form – This form is intended to be used by tenants or parties involved in a tenancy and lease agreement. The form is provided to the tenant who has submitted an application for housing and social services. In the form, the tenant will have to disclose his name along with his social security number and date of birth. The name of the agency or the organization who wanted to have his information will also be required to be stated in the form as well as the name of the witness who is present when the consent was signed and submitted by the tenant.

Consent to Release Information Form

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Release Health Information Form – The user of this form is the patient of a health care provider or agency. The form is composed of nine sections wherein the first section is the patient information section for the details of the patient. The second section is an optional section to be filled out only if the person filling out the form is the patient’s representative. In the third section, the name of the requesting organization with its address and authorized personnel’s identification will be stated while the fourth section collects the information of where the form must be sent. The fifth section specifies the information to be released by the patient’s health care provider. In addition, the sixth section is for the indication of whether the patient permits an interview to be conducted or not, while the last three sections are for reasons, consent, and signature of the patient.

Release Health Information Form

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General Release of Authorization Information Form

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To conclude, a general release of information form is an important document which not only protects the owner of the information to be disclosed but also the organization disclosing the information. With this form, the organization will be able to have a documented proof that they were authorized for the release and have met the request of the data owner, especially if there will be disputes regarding privacy and confidentiality.

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