Form HEA8019 Authorization to Release Information - Help Me Grow - Ohio

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Form HEA8019 Authorization to Release Information - Help Me Grow - Ohio

What Is Form HEA8019?

This is a legal form that was released by the Ohio Department of Health - 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 Form HEA8019?A: Form HEA8019 is the Authorization to Release Information for the Help Me Grow program in Ohio.

Q: What is the Help Me Grow program in Ohio?A: Help Me Grow is a program in Ohio that provides early intervention services for infants and young children with developmental delays or disabilities.

Q: Why do I need to complete Form HEA8019?A: You need to complete Form HEA8019 to give consent for the Help Me Grow program to share information with other agencies or individuals involved in your child's care.

Q: Who should complete Form HEA8019?A: The parent or legal guardian of the child should complete Form HEA8019.

Q: What information do I need to provide on Form HEA8019?A: You will need to provide your child's name, date of birth, and other identifying information, as well as your contact information and signature.

Q: How long does it take to process Form HEA8019?A: The processing time for Form HEA8019 may vary depending on the Help Me Grow office. It is best to contact your local office for more information.

Q: Is there a fee for submitting Form HEA8019?A: No, there is no fee for submitting Form HEA8019.

Q: Can I revoke the authorization on Form HEA8019?A: Yes, you can revoke the authorization at any time by submitting a written notice to your local Help Me Grow office.

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Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Ohio Department of Health;
  • 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 printable version of Form HEA8019 by clicking the link below or browse more documents and templates provided by the Ohio Department of Health.

Download Form HEA8019 Authorization to Release Information - Help Me Grow - Ohio

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