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Form SFN61353 Authorization to Disclose Protected Health Information - Crime Victims Compensation - North Dakota
What Is Form SFN61353?
This is a legal form that was released by the North Dakota Department of Corrections & Rehabilitation - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form SFN61353?
A: Form SFN61353 is a document used in North Dakota for authorizing the disclosure of protected health information related to crime victims compensation.
Q: What is the purpose of Form SFN61353?
A: The purpose of Form SFN61353 is to grant permission to healthcare providers to release protected health information to the Crime Victims Compensation Program in North Dakota.
Q: Who should complete Form SFN61353?
A: The individual who is seeking crime victims compensation in North Dakota should complete Form SFN61353.
Q: Is Form SFN61353 specific to North Dakota?
A: Yes, Form SFN61353 is specific to North Dakota and is used for authorizing the disclosure of protected health information related to crime victims compensation in the state.
Form Details:
- Released on March 1, 2019;
- The latest edition provided by the North Dakota Department of Corrections & Rehabilitation;
- 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 printable version of Form SFN61353 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Corrections & Rehabilitation.
