AUTHORIZATION TO RELEASE ACCOUNT INFORMATION 2025

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This Disclosure Authorisation Letter (previously known as an Authorisation to Release Confidential Information) refers to a Confidentiality Agreement and authorises a party to that agreement to release certain information to a named party. This document is suitable for basic disclosure situations only.
Authorization for release of information means the form prescribed by the agency for the purpose of authorizing the release of a confidential record, signed and dated by the person empowered to release the information.
A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.
Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.