Release of Information: HIPAA AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION

What is a Release of Information?

A Release of Information is a document that gives a consumer the opportunity to decide what material they want released from their medical file, who they want it delivered to, how long the data can be issued, and under what statutes and guidelines it is released.

Click any block below to expand details about the topic displayed.

Duplicate the Release of Information Template Form

Keep the Release of Information template provided intact by always duplicating it prior to making any changes or edits. To duplicate the Release of Information template:

1. Click Dynamic Forms tab in primary navigation bar.
2. Scroll or use the column filters to search for the Release of Information form.
3. Click Actions and select Duplicate button for desired Dynamic Form.
4. Duplicated form displays just below the original with a 1 behind it to indicate it is a copy.
   

Edit the Release of Information Template

Once the duplicate is created you begin by changing or adding a descriptor to the name to indicate that it is your version of the template.

Form Name

1. Navigate to Dynamic Forms and locate your duplicate GFE template by searching the Form Name or scrolling through the list.
   Following the steps above would have named it Good Faith Estimate 1 (or a higher number if you have duplicated it multiple times).
2. Select Edit on the Actions dropdown menu.
   
3. Change the Form Name. It is recommended to add your practice name to the end.
   

   IMPORTANT: DO NOT change the Form Type (Case Form) or Form Use (I need to use this form multiple time per client) fields.

4. Click Save Form. This saves the form name and you can continue editing.

Each section below will review groups of form elements and information about each group. 

Section Headers

The form begins with a Section Header, Date element and Section Header.

1. HIPAA AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION is the form title which will appear on all forms. This may be modified and you may add your practice name in the Subheading Title below. Keep in mind that it will appear on the form for ALL clients unless edited.
2. Date is a date field for selecting the date the form is completed.
3. Patient Information is a header that creates a section for the patient information.
   
   

Patient Information

Patient Information fields are Dynamic Fields (shaded in gray). that are imported from Client Details. The following are included on the form:

• Client Full Name
• Client's Date of Birth
• Client's ID Number

An additional form element for SSN is included with the Client Details which can be entered in the next element. The SSN may be used or removed at your discretion.

The remaining elements are the basic information for the Disclosure of Health Information.

Adding and Removing Form Elements

1. Add additional form elements by dragging them to the desired place under Edit Form.
2. Remove Dynamic Elements by clicking the red trash can beside the element to be removed.
   
3. Regular Form Elements contain text and information included on the form and can be edited by selecting and adding or editing the existing text. The fields may be anyone of the following formats:

   • Section Header  - Add a headline/title for a section or field. Section Headers appear bolded in form. 

   • Short Answer - This adds a field for short answers. Text box is for one word answers such as email address, date, number or URL. Dashes and special characters are not allowed in text boxes.

   • Paragraph Answer - Paragraph Answer adds a field for longer answers. You cannot limit the amount of information that you can enter. This for larger explanation type answers.

   • Check Box - This allows you to add selectable options. Users can select multiple check boxes. You can drag and drop options to desired order.

   • Dropdown - Dropdown allows you to add a multiple choice selection. Add dropdown responses in the order you would like them displayed to Client.

   • Text Box - Text Box allows you to enter form text such as instructions or information. Text boxes do not require action. Copy and paste any text in. Hit enter to create space/paragraphs within the text.

Working with the Release of Information Form

The Release of Information form is a Case form and is accessed from a tab under Client Details > Notes. As it is completed by the client, it is not necessary for you to complete it. You can:

• print the form.
  It will contain the Client Full Name, Date of Birth and Client ID number, the rest will be blank. You can then save the form and use the print function to create a pdf to print and provide to the client as hard-copy or sent via secure messaging.
• add to your Intake Forms. Clients can complete it and return electronically through the Client Portal. It will be saved in their General Documents tab in Client Details.

Save and print the Release of Information:

1. Open the Client Details for the desired client.
2. Click Notes and select the Release of Information: HIPAA AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION tab.
3. Select +Fill New Form to open a new form.
4. Click Save and then print to open a new window with a pdf version of the form.
5. Save the pdf version.
6. Either print the pdf to give to the client or send to the client via secure messaging.
   

Send the Release of Information as an Intake Form:

1. Locate your duplicate copy of the Release of Information.
2. Click Copy to Intake Forms from the Action drop down.
3. The form may now be sent as an Intake Form via the Client Portal.