Release of information form and missing charts

When patients arrive in the clinic for the first time, you should give them a release of information form to sign. A release of information form gives you permission to disclose information that is written in their record. Whenever you give your patients a release of information form to sign, it must be specific on what can be release and to whom.

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  • Create a letterhead. The name of the office is The Peoples Clinic. The address is 1000 N. Lake, Chicago, IL 00001-0000.
  • The name of the patient is Jane Doe.
  • Only lab results can be released to her husband John Doe.
  • Jane’s birthdate is October 12, 1970.
  • Their address is 1000 North Street, Aurora, IL 00001-0000.
  • The purpose is for notification.
  • All consent forms are good for one year.
  • All consent forms must be signed by the patient for validation.
  • Sign the consent form as if you are signing for the patient.

Part II
As part of your duties, you may need to locate a missing record if your practice has not yet converted their records to electronic files. Write a half-page paper on the steps you would take to locate a missing chart that is not in the file cabinet.


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