Get Confidential Authorization To Release

Filling out the Confidential Authorization to Release form is an essential step for students seeking specific accommodations due to medical conditions. This guide provides clear instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the Confidential Authorization To Release form.

1. Press the ‘Get Form’ button to access the form in your document management system.
2. In the first blank, enter your full name clearly as it appears on your official documents.
3. Next, add your date of birth in the specified format.
4. Include your Student ID number in the designated box to help verify your student status.
5. Read the authorization statement carefully. This section confirms that you allow the release of your medical information to the University of Houston Center for Students with DisABILITIES.
6. Initial next to the applicable sections to grant permission for your medical information to be disclosed to specified parties like UH faculty, standardized testing agents, and other institutions.
7. If you want to authorize additional individuals (e.g., family members), initial next to that section and provide their names and your relationship to them.
8. Review the statement that discusses confidentiality and the liability release associated with the information disclosure.
9. Sign the document in the designated area for the student's signature and include the date of signing.
10. If the student is under 18, a parent or guardian must sign the form as well in the appropriate section.
11. After completing the form, ensure all information is accurate before saving your changes, downloading, printing, or sharing the completed document.

Complete your documents online with confidence and ensure your medical information is shared securely.