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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 WCB-220-B
for the current year.
Form WCB-220-B Limited Release of Medical / Health Care Information Related to Substance Abuse - Maine
What Is Form WCB-220-B?
This is a legal form that was released by the Maine Workers' Compensation Board - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form WCB-220-B?A: Form WCB-220-B is a Limited Release of Medical/Health Care Information Related to Substance Abuse in Maine.
Q: What is the purpose of Form WCB-220-B?A: The purpose of Form WCB-220-B is to authorize the release of medical/health care information related to substance abuse in Maine.
Q: Who needs to use Form WCB-220-B?A: Form WCB-220-B is used by individuals who want to authorize the release of their medical/health care information related to substance abuse in Maine.
Q: What information is released using Form WCB-220-B?A: Form WCB-220-B releases medical/health care information related to substance abuse, including diagnosis, treatment, and medications.
Q: Is Form WCB-220-B mandatory?A: Form WCB-220-B is not mandatory, but it is required if you want to authorize the release of your medical/health care information related to substance abuse in Maine.
Q: Are there any fees associated with Form WCB-220-B?A: There are no fees associated with Form WCB-220-B.
Q: How long is Form WCB-220-B valid for?A: Form WCB-220-B is valid for two years from the date of the signature.
Q: Can I revoke my authorization on Form WCB-220-B?A: Yes, you can revoke your authorization on Form WCB-220-B at any time by providing a written notice to the recipient of the information.
Q: Can I use Form WCB-220-B for a different purpose?A: No, Form WCB-220-B can only be used to authorize the release of medical/health care information related to substance abuse in Maine.
Form Details:
- Released on September 1, 2018;
- The latest edition provided by the Maine Workers' Compensation Board;
- 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 WCB-220-B by clicking the link below or browse more documents and templates provided by the Maine Workers' Compensation Board.
