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.
Medical Authorization Form For Adults In Washington
Category:
State:
Multi-State
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
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Complete the General Information for Authorization form (13-835) with all supporting documentation and fax it to: 1-. Use the tab key on a computer to move between fields.Signatures: In general, a patient age 18 or older has legal authority to sign this form. By signing this form, I give my specific authorization for this information to be released. The medical record information release (HIPAA) form allows patients to give authorization to a 3rd party and access their health records. However, Washington State law has exceptions to these general rules. Below you'll find forms that may be applicable to your primary or specialty care appointment or procedure.