Ors 192 566 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated field at the top of the form. This identifies you as the individual authorizing the disclosure.
3. In the next section, you will see checkboxes for various purposes of disclosure. Initial next to each applicable purpose that applies to your situation, such as providing information about your condition or assisting with insurance matters.
4. If any sensitive information is involved, such as HIV/AIDS or mental health records, ensure you initial next to those specific types of information to authorize their disclosure.
5. Review the expiration options for this authorization and select one by checking the appropriate box. You can choose between one year after signing, two years after death, or specify a date.
6. Finally, sign and date the form at the bottom. If you are signing on behalf of someone else, indicate your legal authority.

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