Get How To Use Your Medicare Authorization To Disclose PHI Form

A “Consent to Release” document is used by an individual or entity that does not represent the beneficiary but is requesting information regarding the beneficiary's conditional payment information.

Consent to Release – The beneficiary has authorized an individual or entity to receive certain information from the BCRC for a limited period of time.

1-800-MEDICARE (1-800-633-4227) If you want Medicare to be able to give your personal information to someone other than you, you need to fill out an "Authorization to Disclose Personal Health Information."

By law, Medicare must have your written permission (an “authorization”) to use or give out your personal medical information for any purpose that isn't set out in the privacy notice contained in the Medicare & You handbook.

Fill out and submit an electronic authorization form online at Medicare.gov/forms-help-and-resources/forms/medicare-forms.html. This lets someone call and speak immediately on your behalf. If you submit the form by mail, it generally takes a few weeks before permission is in place for someone to speak on your behalf.

A “consent to release” document is used by an individual or entity who does not represent the Medicare beneficiary but is requesting information regarding the beneficiary's conditional payment information.

Fill out and submit an electronic authorization form online at Medicare.gov/forms-help-and-resources/forms/medicare-forms.html. This lets someone call and speak immediately on your behalf. If you submit the form by mail, it generally takes a few weeks before permission is in place for someone to speak on your behalf.

“1-800-MEDICARE Authorization to Disclose Personal Health Information” Form. By law, Medicare must have your written permission (an “authorization”) to use or give out your personal medical information for any purpose that isn't set out in the privacy notice contained in the Medicare & You handbook.