Gathering information is vital for every type of transaction in any organization. However, there is certain data that a person will not be able to easily lay his hands on for either two reasons: the data is confidential, or that person is not authorized.

Medical professionals, financing agents, employers, and even faculty members need to submit a Release Authorization Form to allow themselves to access the information of a particular person. By observing a proper authorization process, the confidential information will be kept secured and will only be distributed to the people whose names are stated on the authorization form document.

Release of Information Authorization Form Sample

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Authorization for Release of Information

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Medical Records Release Authorization

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Student Information Release Authorization

Document Release Authorization

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Health Information Release Authorization

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Student Information Release Authorization

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Parts of a Release Authorization Form

  • The Authorizing Individual. This refers to the details of the person who gives the authorization. The name, address, contact numbers, and date of birth are the common information found on this section.
  • The Information to be Released. The authorizing individual will have to state the specific entry of information that he wants to disclose to the authorized person. It is important that this section should be well-detailed to avoid disclosing unnecessary data which are excluded from the authorization.
  • The Terms and Rights of the Authorizing Individual. The rights will include the authorizing individual’s choice to either accept or decline the form, to withdraw the authorization at any time, and to specify an approximate authorization expiry date.
  • The Signature of the Authorizing Individual. In the event that the authorizing individual will have a personal representative, a document that proves the representative’s legal identity and relation to the individual should be attached with the authorization form. A date should also be written beside the signature of the individual and the representative.

Authorization Forms are common in the medical industry, especially if a patient is under a healthcare provider’s benefits. A Medical Authorization Form may be completed by the administering physician to acquire the medical records of his patient.

Authorization to Release Protected Health Information

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Signature Release Authorization Form

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Criminal Record Information Release Authorization

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Patient Information Release Authorization

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Applicant Release and Authorization

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Transcript Release Authorization Form in PDF

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Employment Records Release Authorization

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Disclosure Release Authorization Form

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Significant Sectors that Uses Release Authorization Forms

Medical and healthcare agencies. In this field, a Medical Release of Information Authorization Form will be required to have the documents of the patient. A relative of the patient may also use an authorization form under this category especially of the patient is a minor and requires a guardian ad he stays in the medical clinic. The patient’s parents will have to sign the form and indicate that they allow the guardian to take care of their child.

Finance and accounting industry. This includes banks and other agencies who deal with depositing and withdrawing money. A Financial Authorization Form is also used by business men in allowing their trusted representatives to transact an amount on their behalf.

Educational Institutions. The records of a student’s grades and transcript from the previous university will be disclosed with the aid of a Transcript Release Authorization Form.

Companies and employment. This is the most common among these four sectors since employers are well-known for sending out an authorization to access their employees’ employment history, salary, and previous income statements. An Employment Authorization Form should be signed by the employee to allow the employer in viewing his information and do a reference check from his previous company.

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