Authorization Form for the Use and Disclosure of Protected Health Information - City of Chicago, Illinois
Form DOJ-555 Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act
DD Form 2870 Authorization for Disclosure of Medical or Dental Information
Form NIH2923 Authorization for Disclosure of Information
Form IHS-810 Authorization for Use or Disclosure of Protected Health Information
VA Form 0710 Authorization for Release of Information Protected Under the Fair Credit Reporting Act (Title 15, Section 1681)
Form DOC0241 Authorization for Release of Offender Medical Health Information - Illinois
PS Form 2181-D Disclosure and Authorization for Consumer Reports and Investigative Consumer Reports
IRS Form 14462 Authorization for Disclosure of Information - IRS Return Preparer Office
Form CMS-10106 Authorization to Disclose Personal Health Information Release Form
Formulario PS6D Autorizacion Para Revelar Informacion Confidencial Programas De Tratamiento Para La Salud Mental (Spanish)
Form IOCI15-337 Authorization to Utilize Unencrypted E-Mail to Communicate Protected Health Information - Illinois
DHS Form 11000-9 Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act
Privacy Waiver and Authorization for Disclosure to a Third Party
IRS Form 8821-A IRS Disclosure Authorization for Victims of Identity Theft
Formulario CMS-10106 Formulario De Autorizacion Para Divulgar Informacion Medica Personal (Spanish)
VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges
VA Form 10-5345 Request for and Authorization to Release Health Information
VA Form 10-0527-CHOICE Request and Authorization to Release Protected Health Information to the Choice Program
VA Form 10-10164 Opt-Out of Sharing Protected Health Information Through Health Information Exchanges
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