Authorization release information 2026

1. Click ‘Get Form’ to open the authorization release information in the editor.
2. Begin by entering the date at the top of the form. This helps establish when the authorization is being made.
3. Fill in your name and birthdate in the designated fields to identify yourself as the patient.
4. Indicate who verified your ID by entering their name in the 'ID VERIFIED BY' section.
5. In the 'AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION' section, specify the name of the person or facility that holds your health information.
6. Select one or more purposes for this release by checking the appropriate boxes, such as continuity of care or billing.
7. Provide full details of where to send your health information, including street address, city, state, and zip code.
8. Specify what type(s) of health information you authorize to be released and include relevant dates of treatment.
9. If applicable, mark any additional boxes for sensitive information that you specifically authorize for release.
10. Finally, sign and date the form at the bottom. Ensure you also indicate your relationship to the patient if necessary.

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