The Authorization for Use and Disclosure of Protected Health Information can be downloaded in PDF format which requires free Acrobat Reader. A link is provided below that will access the Acrobat page needed to download the free Acrobat Reader Program.
Click here to download the authorization form (see the instructions below for completing the form)
Click on the button below to download the free Adobe Reader
Instructions for downloading and using The Authorization for Use and Disclosure of Protected Health Information form:
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The form can be either printed out or filled out on your computer and then printed.
To print the form
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Click on the link provided above and the document will open in Adobe Reader
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Click on the printer icon on the browser button bar
To complete the form on the computer
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Click on the link above and the document will open in Acrobat Reader
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Place your cursor over the date and left click the mouse (the flashing cursor bar will appear next to the word 'date'
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Tab to the next field and complete the requested information
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Tab to the next field, the tab key will move the cursor to the next field where an entry can be made
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When all the fields have been completed, follow the instructions above to print the document as it requires an original signature.
Links to information about HIPAA
