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Form HFS3692 Consent to Release Confidential Information - Illinois
What Is Form HFS3692?
This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HFS3692?
A: Form HFS3692 is the Consent to Release Confidential Information form used in Illinois.
Q: What is the purpose of Form HFS3692?
A: The purpose of Form HFS3692 is to authorize the release of confidential information.
Q: Who needs to fill out Form HFS3692?
A: Form HFS3692 needs to be filled out by the individual or their legal representative.
Q: What information is released with Form HFS3692?
A: Form HFS3692 authorizes the release of confidential medical, mental health, substance use, and billing information.
Q: Is Form HFS3692 specific to Illinois?
A: Yes, Form HFS3692 is specific to Illinois and should be used in that state.
Q: Is Form HFS3692 legally binding?
A: Yes, Form HFS3692 is a legally binding document once it is properly filled out and signed.
Q: Can I revoke the consent given on Form HFS3692?
A: Yes, you can revoke the consent given on Form HFS3692 at any time by submitting a written revocation.
Q: Is there a fee associated with submitting Form HFS3692?
A: No, there is no fee for submitting Form HFS3692.
Q: How long is the consent valid on Form HFS3692?
A: The consent on Form HFS3692 is valid for one year from the date it is signed.
Form Details:
- Released on February 1, 2020;
- The latest edition provided by the Illinois Department of Healthcare and Family Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HFS3692 by clicking the link below or browse more documents and templates provided by the Illinois Department of Healthcare and Family Services.
