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DEPARTMENT OF HEALTH SERVICES F82009II (11/2017)STATE OF WISCONSIN Sections 19.35 & 19.36, Wis. Stats.CONFIDENTIAL INFORMATION RELEASE AUTHORIZATIONIIName Person Whose Records Will be Released (Record
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How to fill out confidential information release authorization

01
To fill out the confidential information release authorization, follow the steps below:
02
Start by entering your full name, address, phone number, and email address in the designated fields.
03
Next, provide the name of the person or organization to whom you are authorizing the release of confidential information.
04
Specify the purpose for which the information is being released and the duration of the authorization.
05
Describe the specific information that you are authorizing to be released.
06
Indicate any limitations or conditions on the release of information, if applicable.
07
Sign and date the authorization form.
08
Make a copy of the completed authorization form for your records.
09
Submit the original form to the appropriate person or organization.

Who needs confidential information release authorization?

01
Confidential information release authorization may be required by various individuals or entities, including but not limited to:
02
- Healthcare providers: Patients may need to authorize the release of their medical records to other healthcare professionals or institutions.
03
- Legal professionals: Attorneys may require the release of confidential information to support legal proceedings or to obtain relevant documents.
04
- Employers: Employers may need authorization to access an employee's confidential information, such as background checks or medical records.
05
- Research institutions: Researchers may require authorization to access confidential information for scientific studies or investigations.
06
- Insurance companies: Policyholders may need to authorize the release of confidential information for insurance claims processing.
07
- Government agencies: Certain government agencies may request authorization to access an individual's confidential information for regulatory or investigatory purposes.
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