Santa Ana California Permission To Disclose Health Billing Information
Category:
State:
Multi-State
City:
Santa Ana
Control #:
US-PRM-26
Format:
Word;
Rich Text
Instant download
Description
This is a form signed by an individual who wants to grant permission for a health care provider or hospital to release their medical records and/or billing information to another individual other than the patient as is required by the Health Insurance Portability and Accountability Act (HIPPA).
