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Get the free PDF CDCR 7385, Authorization for Release of Protected Health Information

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ClearSaveDEPARTMENT OF GENERAL SERVICES STATE OF CALIFORNIA Office of Human Resources RELEASE OF MEDICAL INFORMATION DGS OR 4 (Rev. 10/2019) AUTHORIZATION FOR THE RELEASE OF MEDICAL INFORMATION PURSUANT
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To fill out the PDF CDCR 7385 authorization form, follow these steps:
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Open the PDF form in a compatible PDF reader or editor.
03
Start by providing your personal details, such as your full name, date of birth, and address.
04
Fill in the required information regarding the person you are authorizing, including their name and relationship to you.
05
Specify the duration of the authorization by entering the start and end dates.
06
Indicate the specific actions or decisions the authorized person is allowed to make on your behalf.
07
If applicable, include any limitations or conditions for the authorized person.
08
Sign and date the form to confirm your consent and understanding of the authorization terms.
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PDF CDCR 7385 authorization form is usually needed by individuals who want to authorize someone else to act on their behalf.
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This form is commonly used in situations where someone needs assistance in making decisions related to healthcare, financial matters, or legal affairs.
03
It can be used by individuals who are unable to make decisions temporarily or permanently due to medical conditions, age, or other circumstances.
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The authorized person may be a family member, close friend, legal representative, or any other trusted individual who is willing and capable of handling the responsibilities specified in the form.
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The PDF CDCR 7385 authorization is a specific form used by the California Department of Corrections and Rehabilitation to authorize the release of certain information or to grant consent for specific activities regarding an individual's records or status.
Individuals or their representatives who seek to access, obtain, or release sensitive information related to a person's record within the California Department of Corrections and Rehabilitation are required to file the CDCR 7385 authorization.
To fill out the PDF CDCR 7385 authorization, individuals must provide their personal information, specify the purpose of the authorization, and indicate the type of information being authorized for release. It's important to follow any additional instructions provided with the form.
The purpose of the PDF CDCR 7385 authorization is to ensure that individuals can grant permission for the release of their personal information held by the California Department of Corrections and Rehabilitation for official purposes.
The information that must be reported on the PDF CDCR 7385 authorization includes the author's contact details, the recipient's information, the specific records requested, and a description of the purpose for requested access.
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