You usually can get a HIPAA authorization form from a doctor, hospital or other provider. Orange County Community Supports Initiative (OCCSI)-Revised 12.14.18.Here are 3 important documents that you must have in order to be able to participate in the healthcare decisions of mom, dad or any elderly family member. Mail or hand deliver the completed form to any HIM office at the Orange County Health Department with nonexpired state issued photo ID. Fill out ALL sections of this form to allow CalOptima to release your protected health. If you recieve Medicaid through your local department of social service (LDSS), you may fill out form DOH-5247 and submit this with your renewal. Fill out a joint Application for the Program of Comprehensive Assistance for Family Caregivers (VA Form 1010CG).