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Get Form 998
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How to fill out the Form 998 online
Filling out the Form 998 is an essential step for authorizing the disclosure of your alcohol and drug abuse prevention and treatment information. This guide will walk you through the online process of completing the form accurately and efficiently.
Follow the steps to complete the Form 998 online.
- Press the ‘Get Form’ button to access the form and open it in your browser.
- In Section 1, Patient Data, fill out your name using your last name, first name, and middle initial. Include the sponsor's Social Security Number and your date of birth formatted as YYYYMMDD. Enter your complete address and telephone number for contact purposes.
- Move to Section 2, Disclosure. In this section, authorize the 355 MDG ADAPT Program to release your patient information by completing the fields. Specify the name or title of the person or organization receiving the information and provide their address and telephone number. Fill in the purpose for needing this information and any specifics about what information should be released.
- In Section 3, Release Authorization, read the statements carefully and confirm your understanding by marking the appropriate checkboxes. Sign and date the form as the patient or legal representative. If applicable, a witness should also sign in the designated area.
- Finally, review all sections for accuracy, make any necessary adjustments, and then save your changes or download the completed form. You may choose to print or share the form as needed.
Complete the Form 998 online today and ensure your health information is handled according to your wishes.
A § 998 offer must be made in writing and served upon the opposing party up to 10 days before the trial date; the § 998 is not filed with the court. ... If accepted, the § 998 is filed with the court and judgment is entered accordingly, thereby ending the litigation.
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