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This version of the form is not currently in use and is provided for reference only. Download this version of
Form PERS-BSD-35
for the current year.
Form PERS-BSD-35 Authorization to Disclose Protected Health Information - California
What Is Form PERS-BSD-35?
This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form PERS-BSD-35?
A: Form PERS-BSD-35 is an authorization form used in California to disclose protected health information.
Q: What is the purpose of Form PERS-BSD-35?
A: The purpose of Form PERS-BSD-35 is to give consent for the disclosure of protected health information.
Q: Who uses Form PERS-BSD-35?
A: Form PERS-BSD-35 is typically used by individuals who want to authorize the release of their own health information.
Q: What information is needed on Form PERS-BSD-35?
A: Form PERS-BSD-35 requires the individual's name, contact information, and details about the specific information to be disclosed.
Q: Is Form PERS-BSD-35 specific to California?
A: Yes, Form PERS-BSD-35 is specific to California and its regulations regarding the disclosure of protected health information.
Form Details:
- Released on November 1, 2011;
- The latest edition provided by the California Public Employees' Retirement System;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form PERS-BSD-35 by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.
Download Form PERS-BSD-35 Authorization to Disclose Protected Health Information - California
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