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Authorization for Release of Information for Uniform Medical Plan (Pebb and Sebb) Members - Washington
Authorization for Release of Information for Uniform Medical Plan (Pebb and Sebb) Members is a legal document that was released by the Washington State Health Care Authority - a government authority operating within Washington.
FAQ
Q: What is the Authorization for Release of Information for Uniform Medical Plan (Pebb and Sebb) Members?
A: The Authorization for Release of Information is a form that allows the Uniform Medical Plan (Pebb and Sebb) to release your health information to a third party.
Q: Why would I need to complete this form?
A: You may need to complete this form to allow the Uniform Medical Plan to share your health information with another person or organization, such as your doctor or insurance company.
Q: What information will be released?
A: The specific information that will be released will be indicated on the form. It may include your medical records, test results, and other related health information.
Q: Can I revoke or cancel the authorization?
A: Yes, you can revoke or cancel the authorization at any time by submitting a written request to the Uniform Medical Plan (Pebb and Sebb) or the third party that received the information.
Form Details:
- Released on August 1, 2020;
- The latest edition currently provided by the Washington State Health Care Authority;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Authorization for Release of Information for Uniform Medical Plan (Pebb and Sebb) Members - Washington
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