![]() ![]() For consultation regarding who is authorized to sign this form, contact the Health Information Management Division at 1-88.ĭrag and drop your file into the box above or select browse your device to choose your file. There are situations in which this general rule does not apply. If the patient is under the age of 18, the parent or guardian must sign this form. If the patient is 18 years of age or older, the patient is the only person who is permitted to sign this form. Written Directions for How to Electronically Sign and Submit this form. Written Directions for How to Complete this form. Typed signatures or digital signatures enabled by certificates will not be accepted. NOTE: Authorization forms must include a manual/handwritten signature using paper and pen or a manual/handwritten signature on an electronic device using a mouse, stylus, finger, etc. The Health Information Management Division (HIMD) uses an NIH approved secure file sharing service, BOX, to allow for electronic submission of completed Authorization for Release of Information Forms. ![]() ![]() This form can be mailed, faxed, or submitted electronically using the below instructions: If you have any questions about how to complete the form or any questions about the release process, please call us at 88. To request a copy of your NIH Clinical Center records, you will need to complete our Authorization for Release of Information form (Para Español Autorización para la Divulgación de Información Médica). How to Request a Copy of Your Medical Records ![]()
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