Get the free Release of Information Form - Kitsap County Government
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RELEASE OF INFORMATION TO: Washington State Bar Association Washington State Medical Association Washington State Nursing Commission Washington State Board of Psychology Washington State Department
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What is release of information form?
The release of information form is a legal document that authorizes the disclosure of an individual's protected health information (PHI) to a specified person or entity.
Who is required to file release of information form?
The individual or their legal representative, such as a guardian or power of attorney, is required to file the release of information form.
How to fill out release of information form?
To fill out the release of information form, one needs to provide personal information, specify the purpose of the disclosure, indicate the type and scope of information to be released, and sign the form.
What is the purpose of release of information form?
The purpose of the release of information form is to ensure that an individual's PHI is disclosed only with their proper consent and authorization, protecting their privacy rights.
What information must be reported on release of information form?
The release of information form typically requires the reporting of personal identifiers such as name, date of birth, contact information, and specific details of the information to be disclosed.
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