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Medical Record Number: Patient Name: AUTHORIZATION FOR RELEASE OF (PHI) Birth Date: PROTECTED HEALTH INFORMATION SSN (Last Four Digits Only): I authorize releasing PHI to: (name of person/ facility
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01
Begin by downloading the ucla-tms-release-form-newpdf from the official UCLA website.
02
Open the downloaded form using a PDF reader on your computer.
03
Fill in your personal information accurately in the designated fields. This typically includes your full name, address, phone number, and email address.
04
Provide any additional required information specific to the purpose of the form. This could include your UCLA affiliation, program details, or any relevant identification numbers.
05
Read through the entire form carefully and make sure to understand the terms and conditions stated. If you have any questions, seek clarification from the appropriate contact at UCLA.
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Submit the completed ucla-tms-release-form-newpdf to the relevant department or individual at UCLA as instructed.

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Students: If you are a student at UCLA and are participating in any academic or extracurricular programs, you may be required to fill out the ucla-tms-release-form-newpdf. This form is often necessary to authorize the use of your personal information, medical records, or participation in certain activities.
02
Researchers: Individuals conducting research projects affiliated with UCLA may need to utilize the ucla-tms-release-form-newpdf to obtain consent or authorizations from participants or other stakeholders.
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Participants: If you are participating in a program, event, or activity organized by UCLA, you may be asked to complete the ucla-tms-release-form-newpdf. This form allows organizers to obtain necessary permissions and gather relevant information from participants.
Please note that the specific requirements for who needs to fill out the ucla-tms-release-form-newpdf may vary depending on the purpose and nature of the form. It is always essential to follow the instructions provided by UCLA or the appropriate authorities.
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The ucla-tms-release-form-newpdf is a release form used by UCLA for certain transactions or activities.
Individuals or entities involved in transactions or activities specified by UCLA may be required to file the ucla-tms-release-form-newpdf.
The ucla-tms-release-form-newpdf can typically be filled out electronically or by hand, following the instructions provided on the form.
The purpose of the ucla-tms-release-form-newpdf is to gather necessary information and permissions related to specific transactions or activities at UCLA.
The ucla-tms-release-form-newpdf may require information such as personal details, nature of the transaction, and signatures of involved parties.
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