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Authority for Release of Medical Information

Medical Authorization Form Texas In Travis

Category:

Releases and Waivers - Medical

State:

Multi-State

County:

Travis

Control #:

US-00426

Format:

Instant download

Description

Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.

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Fill it out and mail it with your supporting documents to: Medical Access Program, PO BOX 300489, Austin, TX 78703. Purpose. To obtain an individual's authorization to release medical information to: the Texas Health and Human Services Commission (HHSC).Texas Statewide Medical Release Form. Form 6700, Use and Release of Health Information Authorization. Instructions for Opening a Form. To fill out this form and submit via mail or fax, please download the Authorization to Disclose Health Information Form (PDF). Fill out our forms to receive a copy of your medical records. If you have any questions, please call us at 512-440-4075. A complete list of forms can be found at the bottom of this page. Please read the instructions below to ensure that you select the correct form.

Medical Authorization Form Texas In Travis

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