FORM 16-1 AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. In the first section, enter the name of the person or organization you are authorizing to release your health information.
3. Next, specify the recipients of this information by filling in their names and addresses accurately.
4. Indicate whether you authorize all health information or only specific records by checking the appropriate box and providing details if necessary.
5. Select any specific types of sensitive information you wish to disclose, such as mental health treatment or HIV test results.
6. State the purpose for which this information is being disclosed, choosing from options like 'patient request' or specifying another reason.
7. Fill in the expiration date for this authorization to ensure clarity on its validity period.
8. Sign and date the form at the bottom, ensuring that if someone else signs on your behalf, they indicate their legal relationship to you.

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