Forms Catalog Document - 810 :-: IHS :-: Authorization For Use or Disclosure of Health Information

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Authorization For Use or Disclosure of Health Information

This form is used to authorize the disclosure of information from the health record.

Form #: 810
Agency: Department of Health and Human Services
Bureau: Indian Health Service
Common Name: Health Record Disclosure

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	2	305	[3] Fillable + Printable	Adobe Reader Download
	Both Form and Instructions	2	74	[3] Fillable + Printable	Other Client Software

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