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AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION​​ Please review and complete the authorization form carefully. Alabama Medicaid Agency - Permission to Disclose Health Information.Please print all information except signature. This authorization will permit Blue Cross and Blue Shield of Alabama and its business associate(s) on behalf of your Health Plan to disclose your. The Medical Association has developed model authorization forms as well as notice of privacy practices for Medical Association members. This packet contains two (2) Authorization to Release Medical Information forms. Section A : Name and Locations. Direct access to PDF of HIPAA release. Free immediate download of PDF. INSTRUCTIONS: Complete each item below.