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Department of HealthDIVISION OF HEALTH CARE SERVICES Directors Office 4601Business Park Blvd., Bldg. K Anchorage, Alaska 995037167 Main: 907.334.2400 Fax: 907.561.1684Privacy Act Statements privacy

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How to fill out release of information authorization

01

Obtain the release of information authorization form from the appropriate organization or healthcare provider.

02

Complete the personal information section, including your name, address, date of birth, and any other identifying information requested.

03

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

04

Sign and date the form in the presence of a witness, if required.

05

Submit the completed form to the organization or healthcare provider from whom you are requesting information.

Who needs release of information authorization?

01

Anyone who wants to authorize the release of their personal information to a specific individual or organization.

02

Healthcare providers may also need release of information authorization to share medical records with other healthcare professionals or facilities.

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What is release of information authorization?

Release of information authorization is a legal document that allows one party to disclose confidential information about another party to a third party.

Who is required to file release of information authorization?

The party that wishes to disclose confidential information about another party is required to file release of information authorization.

How to fill out release of information authorization?

To fill out release of information authorization, one must provide their personal information, specify the information to be disclosed, and sign the document.

What is the purpose of release of information authorization?

The purpose of release of information authorization is to legally permit the disclosure of confidential information between parties.

What information must be reported on release of information authorization?

The information that must be reported on release of information authorization includes the parties involved, the type of information to be disclosed, and the duration of authorization.

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