Philahmis Client Authorization Release of Information Supplement Form - City of Philadelphia, Pennsylvania

Philahmis Client Authorization Release of Information Supplement Form is a legal document that was released by the Office of Homeless Services - City of Philadelphia, Pennsylvania - a government authority operating within Pennsylvania. The form may be used strictly within City of Philadelphia.

FAQ

Q: What is the Philahmis Client Authorization Release of Information Supplement Form?A: The Philahmis Client Authorization Release of Information Supplement Form is a document used by the City of Philadelphia, Pennsylvania to obtain authorization from a client to release their personal information.

Q: Why is the Philahmis Client Authorization Release of Information Supplement Form needed?A: The form is needed to ensure that the City of Philadelphia has the client's consent to share their personal information with authorized individuals or organizations.

Q: Who needs to fill out the Philahmis Client Authorization Release of Information Supplement Form?A: Clients who receive services from the City of Philadelphia and want their personal information to be shared with others need to fill out this form.

Q: What personal information can be released with the authorization?A: With the authorization, the City of Philadelphia can release personal information such as name, address, Social Security number, medical records, and other relevant details.

Q: How long is the authorization valid?A: The authorization is valid for one year from the date it is signed, unless otherwise specified.

Q: Can the client revoke the authorization?A: Yes, the client can revoke the authorization at any time by submitting a written request to the City of Philadelphia.

Q: Is the Philahmis Client Authorization Release of Information Supplement Form confidential?A: Yes, the information provided on the form is treated as confidential and protected under applicable privacy laws.

Q: Are there any fees associated with submitting the form?A: No, there are no fees required to submit the Philahmis Client Authorization Release of Information Supplement Form.

Q: What should I do if I have questions or need assistance with the form?A: If you have questions or need assistance with the form, you can contact the City of Philadelphia's customer service department for guidance.