Authorization to use or disclose health info 2026

1. Click ‘Get Form’ to open the Authorization for Use and Disclosure of Protected Health Information in the editor.
2. Begin by entering the patient's name in the designated field. This identifies who is authorizing the disclosure.
3. Next, input the name of the healthcare provider who will be using and disclosing the information.
4. Specify the recipient's name and clearly state the purpose(s) for which this information is being disclosed. Be as detailed as possible.
5. In the section regarding super-confidential information, initial next to any applicable categories such as HIV records or psychotherapy records.
6. Indicate which types of Protected Health Information you authorize for disclosure by initialing next to each relevant option, including written medical records and billing records.
7. Fill in the expiration date for this authorization or describe an event that will terminate it.
8. Finally, sign and date the form at the bottom, ensuring a witness also signs if required.

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