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This version of the form is not currently in use and is provided for reference only. Download this version of
Form ODM03397
for the current year.
Form ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio
What Is Form ODM03397?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio?
A: ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio is a document used in Ohio to authorize the release or use of protected health information.
Q: Who uses ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio?
A: This document may be used by individuals in Ohio who need to authorize the release or use of their protected health information.
Q: What is the purpose of ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio?
A: The purpose of this document is to provide consent and authorization for the release or use of an individual's protected health information in Ohio.
Q: Is ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio legally binding?
A: Yes, ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio is legally binding once signed by the individual giving consent.
Form Details:
- Released on February 1, 2016;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM03397 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
