California santa clara county 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the introductory section, which outlines how your information will be used and shared. This is crucial for understanding your rights.
3. In the authorization section, initial next to the types of protected personal information (PPI) and protected health information (PHI) you consent to share. Ensure you understand each type before initialing.
4. Fill in the expiration date for your consent at the designated spot. This is important as it determines how long your consent remains valid.
5. Sign and date the form at the bottom. If someone else is signing on your behalf, indicate their relationship to you.

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