Form DWS-ESD114AR Authorization to Disclose Medical Eligibility Information - Utah
Authorization to Disclose Health Information to Other Providers - Utah
Authorization to Disclose Health Information to Health Clinics of Utah - Utah
Authorization to Disclose Health Information for the Division of Medicaid and Health Financing and the Department of Workforce Services - Utah
Authorization to Use and Disclose Protected Health Information - Utah
DWS-UI Form 682 Direct Deposit or Utah Debit Card Authorization Form - Utah (English/Spanish)
Form DWS-ESD/WDD114MC Mycase Authorization to Release Information to a Third Party - Utah
Form 308 Authorization to Disclose, Release and Use Protected Health Information Non-permanent Total Disabilty Claims (10 Years of Records) HIPAA Compliant - Utah
Form 308 Authorization to Disclose, Release and Use Protected Health Information Permanent Total Disabilty Claims (15 Years of Records) HIPAA Compliant - Utah
Formulario DWS-WDD115C-SP Autorizacion Para La Divulgacion De Informacion Personal Y Consentimiento Para Recibir Servicios Coordinados - Utah (Spanish)
Formulario DWS-ESD/WDD114MC Autorizacion De Mycase Para Divulgar Informacion a Terceras Personas - Utah (Spanish)
Formulario DWS-ESD/WDD114MC-SP Autorizacion De Mycase Para Divulgar Informacion a Terceras Personas - Utah (Spanish)
Form SSA-827 Authorization to Disclose Information to the Social Security Administration (Ssa)
Form CMS-10106 Authorization to Disclose Personal Health Information Release Form
VA Form 21-0845 Authorization to Disclose Personal Information to a Third Party
VA Form 29-0975 Authorization to Disclose Personal Information to a Third Party (Insurance)
VA Form 21-4142 Authorization to Disclose Information to the Department of Veterans Affairs
Formulario PS6D Autorizacion Para Revelar Informacion Confidencial Programas De Tratamiento Para La Salud Mental (Spanish)
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
Instrucciones para Formulario SSA-827 Authorization to Disclose Information to the Social Security Administration (Ssa) (Spanish)
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