Consent to Disclose Health Information Form 2026

1. Click ‘Get Form’ to open the Consent to Disclose Health Information Form in the editor.
2. In Section A, enter the Patient/Client Information, including the name, date of birth, and personal health number.
3. Move to Section B and specify what health information you want disclosed. Include details such as the AHS location and time period of records.
4. In Section C, provide the name and address of the individual or organization receiving the health information.
5. Section D requires you to state the purpose for disclosure. Clearly articulate your reason for requesting this information.
6. If applicable, complete Section E by identifying yourself as an Authorized Representative and select the appropriate option that describes your relationship to the patient/client.
7. Finally, in Section F, authorize disclosure by signing and dating the form. Ensure all contact information is accurate before submitting.

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