Form H2076 Authorization to Release Medical Information - Texas

What Is Form H2076?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form H2076?
A: Form H2076 is the Authorization to Release Medical Information form.

Q: What is the purpose of Form H2076?
A: Form H2076 is used to give permission to release medical information to a specified individual or organization.

Q: Who uses Form H2076?
A: Form H2076 is used by individuals in Texas who want to authorize the release of their medical information.

Q: What information is required on Form H2076?
A: Form H2076 requires the individual's name, date of birth, social security number, the name of the person or organization receiving the information, and a description of the information to be released.

Q: Is there a fee for submitting Form H2076?
A: No, there is no fee for submitting Form H2076.

Q: How long is Form H2076 valid?
A: Form H2076 is generally valid for one year from the date of signature, unless otherwise specified.

Q: Can I revoke or cancel the authorization on Form H2076?
A: Yes, the individual can revoke or cancel the authorization at any time by submitting a written request to the healthcare provider or organization.

Q: Are there any limitations to the release of medical information with Form H2076?
A: Yes, there may be limitations based on state and federal laws, such as protecting certain sensitive information or exceptions for certain types of providers or organizations.

Q: Can Form H2076 be used for minors?
A: Yes, Form H2076 can be used for minors, but it may require additional consent from a parent or legal guardian depending on the circumstances.