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2024 MSB Annual Conference Session AV/Consent Form Please provide as much detailed information as possible, so we can provide a great experience. Session Information: Clinic: ___ Presenter: ___ Title:
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Avconsent form MSBO is a consent form that allows individuals to authorize the Mississippi State Board of Optometry (MSBO) to release their personal and protected health information to designated parties.
Anyone receiving optometry services in Mississippi and wishes to authorize the release of their medical information is required to file avconsent form MSBO.
To fill out the avconsent form MSBO, individuals must provide their personal information, specify the parties authorized to receive their medical information, and sign and date the form.
The purpose of avconsent form MSBO is to ensure that individuals' medical information is only shared with authorized parties as per their consent.
The avconsent form MSBO must include the individual's name, contact information, the designated parties authorized to receive medical information, and the effective date of the consent.
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