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Authorization release information 2026
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- Click ‘Get Form’ to open the authorization release information in the editor.
- Begin by entering the date at the top of the form. This helps establish when the authorization is being made.
- Fill in your name and birthdate in the designated fields to identify yourself as the patient.
- Indicate who verified your ID by entering their name in the 'ID VERIFIED BY' section.
- In the 'AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION' section, specify the name of the person or facility that holds your health information.
- Select one or more purposes for this release by checking the appropriate boxes, such as continuity of care or billing.
- Provide full details of where to send your health information, including street address, city, state, and zip code.
- Specify what type(s) of health information you authorize to be released and include relevant dates of treatment.
- If applicable, mark any additional boxes for sensitive information that you specifically authorize for release.
- Finally, sign and date the form at the bottom. Ensure you also indicate your relationship to the patient if necessary.
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