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  • Tehama County Authorization For Release Of Medical Information Form

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Te of Birth: MI F Student ID#: B. INFORMATION TO BE RELEASED FROM: School District California Children s Services (CCS) CCS Medical Therapy Unit St. Elizabeth Community Hospital Mercy Medical Center, Redding Tehama Co. Public Health Tehama Co.Dept. of Education Tehama Co. Health Center Tehama Family Fitness Center U.C. Davis Medical Center Lassen Medical Group, Red Bluff Redding Medical Center Lassen Medical.

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(a) Patients may authorize the release of their health care information by completing the CDCR 7385, Authorization for Release of Protected Health Information, to allow a family member or friend to request and receive an update when there is a significant change in the patient's health care condition.

What Is a Release of Information? A release of information is a document that gives a consumer the opportunity to decide what material they want released from their medical file, who they want it delivered to, how long the data can be issued, and under what statutes and guidelines it is released.

Welfare and Institutions Code section 14124.1 (which relates to Medi-Cal patients) specifies a ten-year retention period.

Instructions: This form is to be used by a patient or legal representative to authorize the release of information to a third party (other than a family member or friend) such as an insurance company, employer, or for legal purposes, etc.

You can visit your local county human services office. You can use your information to confirm your Medi-Cal eligibility and get a temporary identification card. This will allow you to get services until your enrollment is complete.

Please call (916) 650-0490 for further information. If none of these circumstances apply, please complete the form. To continue with your request for access to your Medi-Cal records, please go to page 2 and indicate which records you wish to get a copy of.

Telephone Service Center 1-800-541-5555 The Telephone Service Center (TSC) is available from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Obtaining Your Records The Medical Board of California says that individuals are allowed to make a written request to either review or obtain copies of their medical records under state law.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232