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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION Developed for Texas Health & Safety Code 181.154(d) effective June 2013Please read this entire form before signing and complete all the sections

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What is phone alt?

Phone alt is a form used to report alternative phone numbers for contact purposes.

Who is required to file phone alt?

All individuals and businesses who want to provide alternative phone numbers to be contacted must file phone alt.

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Phone alt can be filled out online or by submitting a paper form with the required information.

What is the purpose of phone alt?

The purpose of phone alt is to provide alternative contact numbers for individuals or businesses.

What information must be reported on phone alt?

The information that must be reported on phone alt includes the primary phone number and alternative phone numbers for contact purposes.

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