Get Flexible Spending Account: Authorization For Release ... - Nc.gov

This guide provides a comprehensive overview of how to complete the Flexible Spending Account: Authorization For Release form online. By following these detailed instructions, users can efficiently fill out and submit the necessary information, ensuring compliance and proper handling of their protected health information.

Follow the steps to complete your authorization form online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. In the participant information section, enter your full name and date of birth as required.
3. Provide your employer's name and your daytime phone number for contact purposes.
4. In the release section, specify the persons or organizations authorized to receive your protected health information.
5. Clearly indicate your relationship to each authorized person or organization.
6. Select the type of information to be disclosed — either all information, account balance information, or restricted details as needed.
7. Indicate the duration of the authorization — whether it is a one-time disclosure or a continuous authorization until cancelled.
8. Read and understand the authorization statement, then sign and date the form.
9. If signing as a power of attorney or personal representative, complete that section and attach the appropriate legal documents.
10. Once completed, save your changes, and choose to download, print, or share the form as needed.

Complete your Flexible Spending Account: Authorization For Release form online today for seamless management of your health information.