Downloadable Forms
To assist parents and caregivers, the staff of the Division of Psychiatry at Cincinnati Children's Hospital Medical Center provides downloadable Release of Information (ROI) forms online. You may complete the forms at home with the necessary provider information (names, addresses and phone numbers) and bring them with you to the hospital. Typically, the admission nurse gives the ROI forms to parents to fill out at admission.
Ongoing Mental Health Treatment
The Ongoing Mental Health Treatment ROI form is used exclusively by the Division of Psychiatry and allows you to designate up to four outpatient providers to which to send information.
You can download the form below in portable document format (.pdf).
You must have Adobe Acrobat" Reader installed on your computer to read this file. You can download Adobe Acrobat" Reader at Adobe's Web site by selecting the version appropriate for your type of computer.
Use and/or Disclosure Of Protected Health Information to Schools
ROI form for schools allows records that you designate to be sent to your child's school. This form is exclusively for the schools and does not list outpatient providers.
To download the School ROI form, see Obtain Medical Records.
