Physician / Provider / Facility Authorization for Release of Information - California

Physician/Provider/Facility Authorization for Release of Information is a legal document that was released by the Medical Board of California - a government authority operating within California.

FAQ

Q: What is a Physician/Provider/Facility Authorization for Release of Information?A: It is a form that allows a physician, provider, or facility to share your medical information with another person or entity.

Q: Why would I need to sign a Physician/Provider/Facility Authorization for Release of Information?A: You may need to sign this form to authorize the release of your medical information to another healthcare provider, insurance company, or legal entity.

Q: Who can request my medical information with a Physician/Provider/Facility Authorization?A: With your authorization, a healthcare provider, insurance company, or legal entity can request your medical information.

Q: Is signing a Physician/Provider/Facility Authorization mandatory?A: No, it is not mandatory. You have the right to refuse to sign this form.

Q: What information can be released with a Physician/Provider/Facility Authorization?A: The information that can be released includes your medical history, test results, treatment plans, and any other relevant medical information.

Q: How long is a Physician/Provider/Facility Authorization valid?A: The validity period of the authorization may vary, but it is typically valid until revoked by the individual who signed it.

Q: Can I specify the purpose or recipient of the released information in the authorization form?A: Yes, you can specify the purpose or recipient of the released information in the Physician/Provider/Facility Authorization form.