916 734 5205 2022-2025 Form

Understanding the HIM Release of Information at UC Davis Health

The HIM Release of Information form is a crucial document for individuals seeking access to their medical records from UC Davis Health. This form allows patients to authorize the release of their health information to specified parties, ensuring that their privacy is maintained while enabling necessary access for treatment, legal, or personal reasons. Understanding the purpose of this form is essential for anyone looking to manage their health information effectively.

Steps to Complete the HIM Release of Information

Completing the HIM Release of Information form involves several straightforward steps:

• Obtain the form from the UC Davis Health website or the health facility.
• Fill out personal information, including name, date of birth, and contact details.
• Specify the type of information to be released and the recipient's details.
• Sign and date the form to confirm your authorization.
• Submit the completed form according to the instructions provided, either online, by mail, or in person.

Legal Use of the HIM Release of Information

The HIM Release of Information form is governed by federal and state laws that protect patient privacy. Under the Health Insurance Portability and Accountability Act (HIPAA), patients have the right to access their health records and control who can view their information. This form serves as a legal document that grants permission for the release of sensitive health data, ensuring compliance with these regulations.

Obtaining the HIM Release of Information Form

Individuals can obtain the HIM Release of Information form through multiple channels. It is available online on the UC Davis Health website, where patients can download and print it. Additionally, physical copies can be requested at the UC Davis Health facilities, ensuring that everyone has access to this essential document, regardless of their technological capabilities.

Key Elements of the HIM Release of Information

Several key elements are essential when filling out the HIM Release of Information form:

• Patient Information: Full name, date of birth, and contact details.
• Information to be Released: Specific details about the medical records being requested.
• Recipient Information: Names and addresses of individuals or organizations receiving the information.
• Signature: The patient’s signature is required to validate the request.
• Date: The date of signing is crucial for processing the request.

Examples of Using the HIM Release of Information

The HIM Release of Information form can be utilized in various scenarios, including:

• Transferring medical records to a new healthcare provider.
• Providing documentation for legal purposes, such as court cases.
• Sharing health information with family members for care coordination.
• Requesting records for personal review or to facilitate insurance claims.