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COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers Compensation 633 17th Street, Suite 400 Denver, CO 80202-3660 Phone: (303) 318-8700 Toll Free: (888) 396-7936 Fax: (303) 318-8710 Clear

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How to fill out wc189 authorization for release

How to fill out wc189 authorization for release:

01

Start by entering your personal information in the designated fields. This includes your full name, address, phone number, and email address.

02

Next, provide details about the medical records or information that you are authorizing for release. Specify the type of information, such as treatment records, diagnostic reports, or laboratory results.

03

Indicate the purpose of the release. State why you are authorizing the release of your medical information. This could be for insurance purposes, legal matters, or for your own personal records.

04

Specify the time period for which the authorization is valid. Indicate whether it is a one-time release or if it covers a specific time frame.

05

Sign and date the authorization form. By signing, you confirm that you understand and agree to release your medical information as specified.

06

If necessary, provide any additional information or instructions in the space provided.

07

Keep a copy of the completed authorization form for your records.

Who needs wc189 authorization for release:

01

Patients who want to obtain copies of their own medical records may need to fill out the wc189 authorization for release form. This is done to ensure that their healthcare providers release the requested information in accordance with privacy regulations.

02

Individuals involved in legal proceedings, such as lawsuits or insurance claims, may also need to complete this authorization form. It allows their medical information to be shared with the relevant parties involved in the case.

03

In some cases, healthcare providers may require a wc189 authorization for release form from patients who wish to transfer their medical records to another facility or specialist. This ensures that the transfer is authorized and complies with privacy laws.

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