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Roger D. Carlson, Ph.D., M. Div., CST, SCH ACE Licensed Psychologist mailing address: 9450 S.W. 52nd Avenue Portland, Oregon 97219 rogerdcarlson gmail.com FAX 5032454478AUTHORIZATION TO USE AND DISCLOSE
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To fill out an authorization of release form, follow these steps:
02
Begin by writing down your full legal name and contact information at the top of the form.
03
Provide the name and contact information of the person or organization you are authorizing to release information on your behalf.
04
Clearly specify the type of information that can be released and the purpose for which it will be used.
05
Indicate the start and end dates for which the authorization is valid.
06
Read the terms and conditions carefully and sign the form at the bottom in the presence of a witness, if required.
07
Make sure to keep a copy of the completed form for your records.
08
Submit the form to the relevant authority or organization as instructed.

Who needs auth-of-release?

01
An authorization of release form is typically needed by individuals who want to authorize someone or an organization to release their information to a third party. This can include situations such as:
02
- A patient authorizing their healthcare provider to share their medical records with another doctor or specialist.
03
- An employee authorizing their employer to release their employment history to a potential employer or background check agency.
04
- A grant applicant authorizing a reference to release information about their qualifications and suitability for the grant.
05
- A legal client authorizing their lawyer to obtain relevant documents or information from other parties involved in a case.
06
- A student or parent authorizing a school to release their academic records to a college or university.
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Auth-of-release is a document that authorizes the release of specific information or materials, typically related to financial or legal matters.
Individuals or organizations requesting the release of information or documentation are typically required to file auth-of-release.
To fill out auth-of-release, provide the required identification details, specify the information to be released, sign the document, and date it.
The purpose of auth-of-release is to legally permit the sharing of sensitive information while protecting the privacy of individuals involved.
The information typically required includes the names of parties involved, the specific information to be released, and the purpose of the release.
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