Form DOC03-475 Authorization for Release / Request of Health Information - Washington

What Is Form DOC03-475?

This is a legal form that was released by the Washington State Department of Corrections - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the purpose of the "Authorization for Release/Request of Health Information - Washington" form?
A: This form is used to authorize the release or request of health information in the state of Washington.

Q: Who needs to fill out this form?
A: Any individual who wants to release or request their own health information or the health information of someone else needs to fill out this form.

Q: Can this form be used to release or request health information from any healthcare provider?
A: Yes, this form can be used to release or request health information from any healthcare provider in the state of Washington.

Q: What information is required to be included on this form?
A: The form requires the individual's personal information, the healthcare provider's information, the purpose of the release or request, the specific information to be released or requested, and the date of the authorization.

Q: Is there a fee associated with submitting this form?
A: The fees for releasing or requesting health information may vary depending on the healthcare provider's policies. It is recommended to check with the healthcare provider for any applicable fees.

Q: How long is this authorization valid?
A: The length of validity of this authorization may vary depending on the healthcare provider's policies. It is recommended to specify the duration of the authorization in the form.