Release of Confidential Information Authorization for Wisconsin Medicaid, BadgerCare Plus, FoodShare 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, where you will provide personal and contact information. Fill in the name of the person whose information will be released, along with their case number (if known), date of birth, and address details.
3. In Part B of Section 1, enter the name and address of the person or organization that will receive the information.
4. Next, complete Part C by specifying the agency or consortia authorized to release this information. Ensure all addresses are accurate.
5. Move to Section 2 to indicate what specific information is authorized for release. Be clear about the purpose for this release and specify an expiration date within 12 months.
6. Finally, in Section 3, read through the statements of understanding before signing and dating the form. This confirms your authorization.

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