Standard authorization form bcbs 2026

1. Click ‘Get Form’ to open the standard authorization form in the editor.
2. In Section I, enter the individual's name, date of birth, social security number, and contact information. Ensure all fields are filled accurately as this identifies the person whose information is being disclosed.
3. Move to Section II and specify the person or organization authorized to receive the protected health information (PHI). Include their relationship to the individual and purpose for receiving this information.
4. In Section III, complete Parts A and B. Indicate whether you authorize the release of sensitive health information by checking 'yes' or 'no'. Then select specific types of PHI you wish to disclose in Part B.
5. Section IV requires you to set an expiration date for the authorization. Choose either one year from the signing date or specify another event that will terminate this authorization.
6. Finally, sign and date in Section V. If applicable, provide details of a personal representative if someone else is signing on behalf of the individual.

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