HIPAA Authorization to Release Information

[NIOSH] World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 233095

Documents and Forms

Document Name Document Type
HIPAA Authorization to Release Information Form and Instruction
HIPAA Authorization Form to Release Information App MM WTC HIPAA Form.docx Form and Instruction
0920-0891 WTCHP Designated Representative HIPAA Authorization_10FEB2025 App L-Designated Representative HIPAA Authorization.pdf Form and Instruction