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AUTHORIZATION TO RELEASE INFORMATION ATHLETIC TRAINING SERVICESPrint StudentAthletes Name___ Date of Birth (DD/MM/BY) ___/___/___ I authorize Northwestern Memorial Healthcare (MHC) and its clinical

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How to fill out authorization to release information

01

Obtain the correct authorization form from the organization or individual requiring the information.

02

Fill out your personal information accurately, including full name, date of birth, and contact information.

03

Specify the information you are authorizing to be released and to whom it should be released to.

04

Sign and date the form, and ensure it is witnessed or notarized as required.

05

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

Who needs authorization to release information?

01

Authorization to release information is typically needed by healthcare providers, insurance companies, employers, and other organizations or individuals who require access to your personal information.

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What is authorization to release information?

Authorization to release information is a written consent form allowing a specific individual or organization to disclose confidential information to another party.

Who is required to file authorization to release information?

Any individual or organization seeking to disclose confidential information to another party is required to file authorization to release information.

How to fill out authorization to release information?

Authorization to release information can be filled out by providing personal details, specifying the information to be disclosed, and signing the form to grant consent.

What is the purpose of authorization to release information?

The purpose of authorization to release information is to ensure the protection of individuals' privacy rights and to regulate the sharing of sensitive information.

What information must be reported on authorization to release information?

Authorization to release information must include details of the parties involved, the specific information to be disclosed, the purpose of disclosure, and any limitations or restrictions.

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