Get Uconn Health Hch-551 2018-2026

The UConn Health HCH-551 form is an authorization document that allows users to obtain or disclose health information. This guide provides step-by-step instructions to assist you in successfully completing the form online, ensuring your information is handled properly.

Follow the steps to fill out the UConn Health HCH-551 online

1. Click ‘Get Form’ button to obtain the form and open it for filling out.
2. Begin by entering the patient’s name in the designated fields marked for last name, first name, and middle initial. Ensure that you include any previous names in the appropriate section.
3. Fill in the date of birth, complete address, and phone number, selecting the appropriate type (home, cell, work) next to the phone number field.
4. Provide the email address where you wish to receive notifications or related communications about your request.
5. In the section that requests authorization details, identify the department name and mail code at UConn Health you are authorizing to disclose or obtain information.
6. Input the name and address of the individual or entity to whom the information is to be disclosed or obtained.
7. Specify the protected health information (PHI) you wish to obtain or disclose by checking the relevant boxes.
8. Indicate the purpose for requesting the information by selecting the applicable option from the provided choices.
9. If requesting physical copies, clarify whether they should be sent as paper copies or in an electronic format.
10. Read and acknowledge the understanding and agreements listed by providing your signature, date, and printed name. Indicate your relationship to the patient if applicable.
11. Ensure that any necessary legal authority documentation is attached if you are signing on behalf of another individual.
12. Once completed, save your changes, and then download, print, or share the form as needed. Make sure to send the completed authorization via the preferred method outlined in the form.

Complete the UConn Health HCH-551 online today to ensure your health information is managed appropriately.