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This document authorizes the release of immunization records and/or tuberculosis screening information to comply with Alaska's 'No-Shots No-School' law, while ensuring confidentiality as per HIPAA

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How to fill out AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS

01

Obtain the AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS form from the relevant institution or website.

02

Fill in your personal details, including your name, date of birth, and contact information.

03

Provide the name and contact information of the person or organization that will receive the records.

04

Specify the purpose for requesting the immunization/TB records.

05

Sign and date the authorization form to confirm your consent for the release of the records.

06

Submit the completed form to the appropriate office or facility.

Who needs AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

01

Individuals who are enrolling in educational institutions.

02

Healthcare professionals who require verification of immunization status.

03

Employers in healthcare settings that mandate proof of immunization.

04

People traveling to areas where certain diseases are prevalent and need proof of vaccination.

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What is AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS is a formal document that grants permission for medical professionals or organizations to disclose an individual's immunization and tuberculosis (TB) record to a third party, such as another healthcare provider or institution.

Who is required to file AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

Individuals who need their immunization or TB records disclosed to another entity, such as schools, employers, or healthcare providers, are required to file AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS.

How to fill out AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

To fill out the form, one must provide their personal information, including name, date of birth, and contact details, specify the records to be released, indicate the recipient of the records, and sign and date the authorization.

What is the purpose of AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

The purpose of this authorization is to ensure that sensitive health information is shared legally and with the consent of the individual, allowing for continuity of care and compliance with vaccination requirements.

What information must be reported on AUTHORIZATION FOR RELEASE OF IMMUNIZATION / TB RECORDS?

The information required includes the individual's full name, date of birth, the specific type of records requested, the name and contact information of the recipient, as well as the individual's signature and date to confirm consent.

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