0US1 Confidential Information Releases. High quality forms. 2

Confidential Information Releases

for Your State

For use when authorizing another to release confidential information on your behalf. This form contains an expiration date and can be used to authorize a physician, attorney, hospital, clinic or school to release confidential information about you.

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File types included

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Compatible with

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  • Mac OS X
  • Linux

For Immediate Download

$19.95
Select state
Add to Cart
Free eSignature included
with every order
Please select a state

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This Authorization to Release Confidential Information will ensure that only the information you specify is released on your behalf. This authorization can be given to a physician, attorney, hospital, clinic or school to release confidential information on your behalf. The types of confidential information to be released can vary from financial, educational and legal to your social interactions, both online and in person. This Authorization to Release Confidential Information is beneficial because it protects not only your privacy but contains an expiration date and can be revoked at any time.

These important provisions are included in this Authorization to Release Confidential Information:
  • Authorization Information: Indicates the name and address of the individual authorizing release of the information and the individual or entity who will release the confidential information;
  • Types of Confidential Information: Sets forth a checklist covering most types of confidential information;
  • Purpose of Use: Outlines the purposes the confidential information may be used for;
  • Revocation and Expiration Dates: This Authorization may be revoked at any time or on a specified expiration date.

Protect yourself and your Rights by using our professionally prepared up-to-date forms.

This attorney prepared packet includes:
  1. General Information
  2. Instructions and Checklist
  3. Authorization to Release Confidential Information
State Law Compliance: This form complies with the laws of all states
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
Number of Pages6
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#34855
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.

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