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BOARD OF OCCUPATIONAL THERAPY 2005 Evergreen Street, Suite 2050, Sacramento, CA 95815-3831 T: (916) 263-2294 F: (916) 263-2701 E-mail: Cabot DCA.ca.gov Web: www.bot.ca.gov AUTHORIZATION TO RELEASE

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What is authorization to release information?

Authorization to release information is a document that allows an individual or organization to provide consent for the disclosure of their personal information to a specified party or parties.

Who is required to file authorization to release information?

The person or entity that is seeking to obtain the personal information of an individual is required to file an authorization to release information.

How to fill out authorization to release information?

To fill out an authorization to release information, you typically need to provide your personal details, specify the information to be released, identify the intended recipient(s) of the information, and sign and date the document.

What is the purpose of authorization to release information?

The purpose of an authorization to release information is to ensure that the disclosure of personal information is done with the explicit consent and knowledge of the individual to whom the information pertains.

What information must be reported on authorization to release information?

The information that must be reported on an authorization to release information generally includes the individual's name, contact information, specific details of the information to be released, the purpose of the release, and the intended recipient(s) of the information.

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