Get Wa Chpw Authorization To Release Confidential Substance Use Disorder Treatment Information 2019-2025
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How to fill out the WA CHPW Authorization To Release Confidential Substance Use Disorder Treatment Information online
This guide provides clear and supportive instructions on how to fill out the WA CHPW Authorization To Release Confidential Substance Use Disorder Treatment Information form online. By following these steps, you will ensure your confidential treatment information is released properly and in accordance with privacy regulations.
Follow the steps to complete your authorization online.
- Click ‘Get Form’ button to obtain the form and open it in the online editor.
- Complete Section 1: Member Identification. Fill in your last name, first name, middle initial, member ID number, address, phone number, city, state, and zip code. If you are a parent or guardian providing consent for a minor's inpatient treatment, please include the minor's name as well.
- In Section 2: Member Authorization for Disclosure of Part 2 Confidential Information, authorize the Community Health Plan of Washington (CHPW) to disclose your treatment information. Provide the entity's name and address to whom the information will be disclosed. You may need to attach a separate sheet if there are multiple entities.
- Indicate the type of information you wish to disclose by selecting appropriate options such as all information, specific claims, billing, or treatment records. Be as explicit as possible while adhering to confidentiality guidelines.
- State the purpose of the disclosure. This information helps to clarify why you are allowing the release of your confidential information.
- Sign and date the form in the designated area. If you are a parent or guardian signing for a minor, include your signature and date on the corresponding lines.
- Finalize by reviewing all entered information for accuracy. Once confirmed, save changes, download the document, print it for your records, or share it as needed.
Start filling out your WA CHPW Authorization To Release Confidential Substance Use Disorder Treatment Information online today.
The confidentiality of substance use disorder treatment records is protected under the federal law known as 42 CFR Part 2. This law specifically governs the disclosure and use of patient information related to substance use disorders. It is crucial for ensuring that individuals seeking help for these issues can do so without fear of their information being shared without consent. Understanding the WA CHPW Authorization To Release Confidential Substance Use Disorder Treatment Information is vital for compliance and protection.
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