This Medical Release Authorization Form allows individuals to authorize the disclosure of medical records for purposes related to workers’ compensation claims, legal cases, or personal medical history review. The form grants permission to healthcare providers, insurance companies, and authorized agents to access and share medical history, treatment records, diagnostic reports, and sensitive health data as specified. It includes provisions for revocation, redisclosure limitations, and HIPAA compliance.
Medical Release Authorization Form
File Type:
pdf
Categories:
Workers Compensation