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OCT Official Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health] Patient Name Date of Biosocial

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How to fill out authorization to permit interview

01

Start by addressing the recipient or organization that will be conducting the interview.

02

Mention the purpose of the interview and the date and time it is scheduled for.

03

Provide details about the individual being interviewed, including their name, contact information, and any relevant background information.

04

Clearly state that you authorize the interview to take place and provide your signature and date at the end of the document.

Who needs authorization to permit interview?

01

Anyone who is not the individual being interviewed but has the authority to grant permission for the interview to take place.

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What is authorization to permit interview?

Authorization to permit interview is a document that gives permission to conduct an interview.

Who is required to file authorization to permit interview?

The person or organization conducting the interview is required to file the authorization to permit interview.

How to fill out authorization to permit interview?

To fill out the authorization to permit interview, you must provide information about the interviewer, interviewee, and the purpose of the interview.

What is the purpose of authorization to permit interview?

The purpose of authorization to permit interview is to ensure that interviews are conducted in a legal and ethical manner.

What information must be reported on authorization to permit interview?

The information that must be reported on authorization to permit interview includes the names of the interviewer and interviewee, the date and location of the interview, and the purpose of the interview.

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