World Trade Center Volunteer HIPAA Authorization {WTC-HIPAA}

WTC HIPAA - WORLD TRADE CENTER VOLUNTEER HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT AUTHORIZATION. This form is used to allow the release of health care records of World Trade Center volunteers. By signing this form, the patient grants permission for their health care information to be shared with the Workers' Compensation Board and the World Trade Center Health Organization for coordinating benefits. The form also includes options to indicate authorization for specific types of information. The patient has the right to revoke this authorization in writing, and the form provides instructions for doing so. If the patient is unable to sign, another person can sign on their behalf. www.FormsWorkflow.com