Release Of Information In Healthcare In Contra Costa

State:
Multi-State
County:
Contra Costa
Control #:
US-00458
Format:
Word; 
Rich Text
Instant download

This form is part of a form package!

Get all related documents in one bundle, so you don’t have to search separately.

Description

The Authorization to Release Wage and Employment Information and Release of Liability form is designed for individuals in Contra Costa seeking to authorize their current or former employer to disclose employment-related information. This essential document facilitates the release of employment history, wages, and other relevant details to specified parties, ensuring a streamlined process for information verification. Key features include the provision for the employee to name the employer and the recipient of the information, as well as a clause indemnifying the employer from liability for releasing the information. Users must ensure all fields are accurately filled, including personal identification details and the signatures of both the employee and employer. This form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants involved in employment law, background checks, or contract negotiations. It allows legal practitioners to effectively support clients transitioning between jobs or verifying employment history while adhering to confidentiality laws. Filling out the form properly maintains clarity and legal integrity, crucial for any employment-related process.

Form popularity

FAQ

1-877-661-6230 The Advice Nurse can tell you if you need to go to urgent care or the emergency room, give you self-care instructions, schedule a telehealth appointment with a doctor, and more! Available 24 hours a day, 7 days a week, 365 days a year. (For medical emergencies, please call 911.)

CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.

Tzvieli, Ori. Dr. Tzvieli has been the County's health officer and Public Health Director since Sept. 2021.

Submitting Claims The claim submission timeframe for Contra Costa Health Plan is 180 days from the date of service, or primary explanation of benefits (EOB), for both contracted and non-contracted providers. Claims received after 180 days will be denied for untimely filing.

CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.

1-877-661-6230 Call if you have a medical problem or if you have a medical question.

Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24-Hour Nurse Advice Line at 1-877-661-6230 (Option 1).

1-877-661-6230.

Call 800-495-8885 800-495-8885 is the central number for making appointments at our county health centers. For same-day or next-day appointments, it's best to call as early as possible.

Trusted and secure by over 3 million people of the world’s leading companies

Release Of Information In Healthcare In Contra Costa