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Authorization to Release Information AEP Customer Name: hereby authorizes American Electric Power (AEP) to release electrical usage information to: Supplier Name: Contact Name: Mailing Address: City:
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How to fill out authorization to release information
How to fill out authorization to release information:
01
Begin by writing your full name and contact information at the top of the authorization form. This will ensure that the healthcare provider knows who is granting permission.
02
Next, specify the recipient of the information. Provide the name and contact information of the individual or organization that you are authorizing to receive your information.
03
Clearly state the purpose of the authorization. Specify the types of information you are authorizing to be released, such as medical records, test results, or treatment information.
04
Include the time period for which the authorization is valid. You can specify a specific date range or state that the authorization remains in effect until revoked in writing.
05
Sign and date the authorization form. Your signature is required to validate the authorization.
06
If applicable, provide any additional details or instructions. For example, if you only want specific information to be released, you can mention it in this section.
07
Keep a copy of the authorization form for your records.
Who needs authorization to release information?
Anyone who wants to access someone else's personal information, such as medical records, needs authorization to release information. This can include healthcare providers, insurers, law enforcement agencies, employers, or other third parties. The authorization is necessary to ensure that the individual's privacy rights are respected and that their information is only shared with authorized parties.
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