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What is an authorization for release of information form?

This form is used to release your protected health information as required by federal and state privacy laws.

What is the Medicare form for sharing information?

1-800-MEDICARE Authorization to Disclose Personal Health Information Form. By law, Medicare must have your written permission (an authorization) to use or give out your personal medical information for any purpose that isnt set out in the privacy notice contained in the Medicare You handbook.

How do I get CMS forms?

Many CMS program related forms are available in Portable Document Format (pdf). Hard copy forms may be available from Intermediaries, Carriers, State Agencies, local Social Security Offices or End Stage Renal Disease Networks that service your State.

What is an authorization to use and disclose protected health information?

A Privacy Rule Authorization is an individuals signed permission to allow a covered entity to use or disclose the individuals protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.