Abp 1676 2-2026

1. Click ‘Get Form’ to open the abp 1676 2 in the editor.
2. Begin by filling in your last name and first name, followed by your date of birth in the specified format (Month/Day/Year).
3. Select the medical facility from which you are authorizing the release of information. You can choose from options like LAC+USC Medical Center or Olive View-UCLA Medical Center.
4. Provide the street address, city, state, and zip code of the selected facility.
5. Indicate where you want your health information shared by filling in the relevant department and office name along with its address.
6. Specify the time period for which this authorization is valid by entering start and end dates.
7. Mark all appropriate boxes for the types of health information you wish to disclose, such as discharge summaries or mental health assessments.
8. Review your entries for accuracy before signing. Ensure that you understand your rights regarding this authorization.

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