Dbhdd authorization 2026

1. Click ‘Get Form’ to open the dbhdd authorization in the editor.
2. Begin by entering the Name of Individual/Consumer/Patient/Applicant and their Social Security Number and/or Date of Birth in the designated fields.
3. In the 'AUTHORIZATION FOR RELEASE OF INFORMATION' section, specify the name of the health care provider holding the information and their address. Ensure you include their phone or fax number for contact purposes.
4. Next, identify the person or agency to whom the information should be given, along with their address and contact details.
5. Indicate which specific information you authorize to be disclosed. If applicable, initial next to any sensitive information such as alcohol or drug abuse records or HIV-related information.
6. Complete the purpose of disclosure section by providing a brief explanation of why this information is being shared.
7. Finally, sign and date the form at the bottom. If necessary, have a witness sign as well, indicating their title or relationship to you.

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