Authorization described 2026

1. Click ‘Get Form’ to open the HIPAA Authorization in the editor.
2. In Section A, enter your name, mailing address, city, state, zip code, telephone number, and either your Social Security number or Participant ID number as assigned by WageWorks.
3. Move to Section B. Specify the Protected Health Information (PHI) you are authorizing for use or disclosure. If applicable, check the box indicating this authorization is for psychotherapy notes.
4. List the entities or persons authorized to use or disclose your PHI. Be specific about who can access this information.
5. Identify the persons or organizations authorized to receive your PHI. Clearly specify their names or classes.
6. State the purpose of this authorization in the designated area. You may select 'At request of individual' or specify another purpose.
7. Complete Section C by indicating when this authorization will expire and acknowledge your right to revoke it at any time.
8. In Section D, sign and date the form. If a personal representative is signing on your behalf, provide their details as well.
9. After signing, keep a copy for your records and submit it to WageWorks via fax or mail as indicated at the bottom of the form.

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