Forms - California Board of Registered Nursing - State of 2026

1. Click ‘Get Form’ to open the Consent to Release Confidential Information form in the editor.
2. Begin by entering your Participant Name, IPN Case Number, SSN, Date of Birth, FL Nursing License Number, and Profession in the designated fields.
3. In the section for authorization, fill in the Name, Credentials, Address, City, State, Zip Code, County, Phone number, and Email of the individual or entity receiving the information.
4. Review the list of information being authorized for release. Ensure that all relevant items such as Participant Contract and Toxicology Test Results are checked off as needed.
5. Read through the consent statement carefully. Confirm your understanding regarding confidentiality and revocation rights.
6. Sign and date the form at the bottom where indicated. Make sure your printed name is also included.
7. Finally, return the completed form to IPN via mail or fax as specified at the end of the document.

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