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Cassandra Bauhaus, PSD., LLC 3010 S Harvard Ave, Suite 110 Tulsa, OK 74114 Office 9187491840 Fax 9182095538 AUTHORIZATION FOR RELEASE OF MEDICAL/MENTAL HEALTH INFORMATION PERSON WHO'S INFORMATION

How to fill out cass release of information

How to fill out CASS release of information:

1. Start by obtaining a copy of the CASS release of information form. This form is typically available from the organization or healthcare provider requesting the release of information.
2. Begin by providing your personal information. This includes your full name, address, date of birth, and contact information. Make sure all the details are accurate and up to date.
3. In the section specifying the recipient of the information, write the name of the organization or healthcare provider to whom you are granting permission to release your information. Include their address and contact information if available.
4. Specify the purpose of the release. Indicate why you are authorizing the release of your information. This could be for medical treatment purposes, insurance claims, legal proceedings, or any other relevant reason.
5. Include the specific information you are authorizing to be released. This may include medical records, test results, treatment history, or any other relevant documents. Be specific and make sure to only authorize the release of information that is necessary for the stated purpose.
6. Specify the time frame for which the release of information is valid. You can indicate a specific start and end date, or you can authorize the release for an indefinite period. Make sure to consider the purpose and duration of the release when choosing the time frame.
7. Sign and date the form. Make sure to read the form carefully and understand its implications before signing. By signing, you are giving your consent for the release of information as specified on the form.

Who needs a CASS release of information?

1. Patients who want to authorize the release of their medical information to a specific organization or healthcare provider.
2. Individuals involved in legal proceedings, such as personal injury cases, where access to medical records is necessary.
3. Insurance claimants who need to grant permission for their healthcare providers to release relevant information to the insurance company for claim processing.
4. Individuals involved in research studies or clinical trials where sharing of medical information is required for the study or trial purposes.
5. Anyone who wants to share their medical information with a third party for any legitimate reason, as long as proper consent and authorization are obtained.

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What is cass release of information?

Cass release of information is a form used to authorize the release of specific information to a third party.

Who is required to file cass release of information?

Any individual or organization that needs to share or obtain confidential information from another party may be required to file a cass release of information.

How to fill out cass release of information?

To fill out a cass release of information, one must provide their contact information, specify the information being released, and sign the form to authorize the release.

What is the purpose of cass release of information?

The purpose of a cass release of information is to ensure that confidential information is only shared with authorized parties in a secure and legal manner.

What information must be reported on cass release of information?

The information that must be reported on a cass release of information will vary depending on the specific details of the authorization being granted.