Get Authorization To Release Information - Iowa Workforce Development - Iowaworkforce

The Authorization To Release Information form is a crucial document for claimants seeking workers' compensation benefits in Iowa. This guide will walk you through the online process of filling out this form, ensuring that you provide all necessary information accurately and efficiently.

Follow the steps to effectively complete your form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In the first section, enter your name and date of birth in the designated fields to clearly identify yourself as the patient.
3. For the authorization of release of information, specify who you authorize to disclose your information by filling in the appropriate entity or individual's name.
4. Indicate to whom you wish your information to be disclosed. Fill in the name of your intended recipient in the appropriate section.
5. Review the options related to the information you are authorizing for disclosure. Ensure you check the appropriate boxes regarding the exclusion of substance abuse, mental health, and AIDS-related information, unless you are granting specific approval.
6. Sign and date the authorization at the bottom of Section I. If you are a legal representative, include your printed name and relationship to the claimant.
7. If relevant, move to Section II, where you can provide further authorization regarding sensitive information. Mark 'YES' or 'NO' in the respective boxes if you consent to the release of substance abuse, mental health, or AIDS-related information.
8. Complete the signature section at the end of Section II if you need to authorize the release of sensitive information. Include your street address and date.
9. Once you have filled out all required sections, review the form for accuracy, then save your changes. You can choose to download, print, or share the completed form as needed.

Once you're ready, complete your documents online and ensure your information is submitted correctly.