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AUTHORIZATION TO SHARE HEALTH INFORMATION WITH A THIRD PARTY Use this form to: Share your health information with someone who is not immediate family (a union representative, lawyer, friend, etc.).

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What is authorization to share health?

Authorization to share health is a legal document that allows the sharing of an individual's health information with specified parties.

Who is required to file authorization to share health?

Any individual or organization that wishes to share an individual's health information must file authorization to share health.

How to fill out authorization to share health?

Authorization to share health can be filled out by providing the required information about the individual whose health information is being shared, the parties receiving the information, and the purpose of sharing.

What is the purpose of authorization to share health?

The purpose of authorization to share health is to ensure that an individual's health information is only shared with authorized parties and for specified purposes.

What information must be reported on authorization to share health?

Information such as the individual's name, date of birth, the information being shared, the parties receiving the information, and the purpose of sharing must be reported on authorization to share health.

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