A signed Release of Information (ROI) is required in order to allow KBH to share/release your information in any capacity. Â
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| Please note: Â if the organization that you are trying to create a release for does not exist in our system, you will not be able to add the release from the Client Portal. Â Please contact the office to have the release added to be signed. |
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Select Release of Information from the options menu.
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Select Add Coordination Release.
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Click the arrow next to Select an Organization to see the organization options.
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Scroll through the list to find the organization that you are looking for. Â You can also begin typing the organization name into the text field, to narrow your search down. Â
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Once you select an organization, the organization, address, phone and fax number will be presented.  Click Add Release to create the release.
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(A) Â The period for which information is requested - this will be from the start of your current episode of care and end one month from date of creation/signature. (B) Â The specific information to be released - All options will be checked off, including Other which will specify Any information needed for coordination of care. (C) The reason for the release of this information is - Coordination of Services option will be checked off. (D) Â If I have been diagnosed or treated for any of the following, I understand that my specific consent to disclose related information is necessary. (Must pick an option for each of the three questions below.)  These will pre-populate with the Do option but can be changed by switching the radio button to Do Not if that happens to be your preference for any of these questions. (F) Â I agree to the future release of information to the above person/organization during the approved time period - this box will automatically be checked off and cannot be changed. (G)This agreement to release information has an expiration date of - This will pre-fill with a date one month from the date you create/sign the release and cannot be changed. |
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If your preferences for selections that cannot be changed differ from what is selected, the document must be completed through a different route. Â If this is the case, don't hesitate to get in touch with the office for assistance.
If/when you are content with all of the chosen options, sign your name in the signature box at the bottom of the page and click Submit .
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Once you submit, you'll see the release listed, with its start and expiration date, with the option to view it by clicking the View  button from the far left column.
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If you chose Do not on any or all of the below questions, staff review is required therefore the release will show In Review.  |
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View the existing release. |
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Sign the release. |
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This release is listed as inactive in our system. Â Click to sign the release and make it active. |
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This indicates that you have signed this release, but have selected an option that requires staff to review the document before it becomes active. Selecting Do Not for any of these options, will initiate the staff review requirement.  |
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