WTC Health Program General HIPAA Authorization to Third Parties

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

OMB: 0920-0891

IC ID: 251023

Documents and Forms

Document Name Document Type
Form 0920-0891 WTC Health Program General HIPAA Authorization to Third Parties Form and Instruction
0920-0891 WTC Health Program HIPAA Authorization - Third Parties App P WTCHP General HIPAA Authorization to Third Parties DRAFT.docx Form and Instruction
0920-0891 General HIPAA Authorization for Disclosures to Third Parties App-P-WTCHP-General-HIPAA-Authorization-to-Third-Parties-updated2024.pdf Form and Instruction
0920-0891 WTCHP HIPAA Authorization Third Parties_10FEB2025 App O-WTCHP-General-HIPAA-Authorization-to-Third-Parties-updated2024.pdf Form and Instruction