Confidential Licensing Information Authorization 2025

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The name or other specific identification of the patient or class of persons, authorized to make the requested use or disclosure The name or other specific identification of the person(s), or class of persons, who are authorized to receive the information A description of each purpose of the requested use or disclosure
In the cases when HIPAA requires authorization to disclose information, that authorization must include the core elements specified by HIPAA. This is necessary when disclosure of protected health information is not permitted by the HIPAA Privacy Rules.
Call us: Find your professions licensing contact number below and select option 1. Email us: dol-bpdcustomersupport@dol.wa.gov.
All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data.
If you plan to use or share Protected Health Information (PHI) when conducting your research, you must conduct your study in accordance with the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA).
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