Authorization to Release Information We are ... - Maine.gov 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the office(s) that should assist you. Check the appropriate boxes for options such as Office of MaineCare Services or Office for Family Independence.
3. Clearly print the individual’s name, date of birth, home address, and contact information in the designated fields.
4. Indicate whether you want to release or obtain information by checking the corresponding box and providing details about the recipient's name and organization.
5. Select the purpose of disclosure from options like personal request or legal matter, ensuring clarity on why this information is needed.
6. If you wish to share information via email, initial in the provided space acknowledging the risks and enter the email address for sending.
7. Check all applicable types of information that should be released or obtained, including health records and billing information.
8. Review and sign at the bottom of the form, ensuring you understand your rights regarding this authorization.

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