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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-72 (BWC-1192)
for the current year.
Form C-72 (BWC-1192) Consent to Release Information - Ohio
What Is Form C-72 (BWC-1192)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-72 (BWC-1192)?A: Form C-72 (BWC-1192) is a Consent to Release Information form in Ohio.
Q: What is the purpose of Form C-72 (BWC-1192)?A: The purpose of Form C-72 (BWC-1192) is to allow the release of information in Ohio.
Q: Who needs to complete Form C-72 (BWC-1192)?A: Anyone who wants to release information in Ohio needs to complete Form C-72 (BWC-1192).
Q: What information can be released with Form C-72 (BWC-1192)?A: Form C-72 (BWC-1192) allows the release of personal and medical information.
Q: Is there a fee to submit Form C-72 (BWC-1192)?A: No, there is no fee to submit Form C-72 (BWC-1192).
Q: Is Form C-72 (BWC-1192) only applicable in Ohio?A: Yes, Form C-72 (BWC-1192) is specific to Ohio and its regulations.
Q: Can I use Form C-72 (BWC-1192) to release information for someone else?A: Yes, you can use Form C-72 (BWC-1192) to release information on behalf of someone else with their permission.
Form Details:
- Released on August 30, 2012;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form C-72 (BWC-1192) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
