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The Office of Congressman Pete Sessions 400 Austin Ave. Suite 302 Waco, TX. 767012139 25463345002700 Earl Rudder Fwy. #4500 College Station, TX. 778452804 9794316340PRIVACY RELEASE FORM DATE:___ NAME:___

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How to fill out privacy release form

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Start by reading the instructions carefully to understand the purpose of the form.

02

Fill in your personal information accurately, including your full name, address, and contact details.

03

Provide details about the person or organization authorized to receive your information.

04

Sign and date the form to acknowledge that you authorize the release of your private information.

Who needs privacy release form?

01

Individuals who want to authorize the release of their private information to a specific person or organization.

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Medical patients who need to allow their healthcare provider to share their medical records with another healthcare provider.

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Individuals participating in research studies that require the sharing of personal data with researchers.

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What is privacy release form?

A privacy release form is a document that authorizes the release of confidential information to a specified individual or entity.

Who is required to file privacy release form?

The person or entity requesting to access the confidential information is required to file a privacy release form.

How to fill out privacy release form?

To fill out a privacy release form, provide the requested personal information and specify the details of the information being released, along with the intended recipient.

What is the purpose of privacy release form?

The purpose of a privacy release form is to ensure that confidential information is released only to authorized individuals or entities.

What information must be reported on privacy release form?

The information that must be reported on a privacy release form includes personal details of the individual requesting access to confidential information, the specific information being released, and the intended recipient.

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