Form PERS-BSD-35 Authorization to Disclose Protected Health Information - California

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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 to Disclose Protected Health Information specific to California.

Q: What is the purpose of Form PERS-BSD-35?A: The purpose of Form PERS-BSD-35 is to obtain consent from the individual to disclose their protected health information.

Q: Who uses Form PERS-BSD-35?A: Form PERS-BSD-35 is typically used by healthcare providers, insurance companies, and other covered entities in California.

Q: What information is required on Form PERS-BSD-35?A: Form PERS-BSD-35 requires the individual's name, contact information, specific information to be disclosed, the purpose of the disclosure, and the expiration date of the authorization.

Q: Is Form PERS-BSD-35 mandatory in California?A: While the use of Form PERS-BSD-35 is common in California, its use may vary depending on the healthcare provider or organization. It is recommended to check with the specific entity regarding their authorization process.

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Form Details:

  • Released on December 1, 2019;
  • 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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