TX HHS Form 2076. Authorization to Release Medical Information

The Texas Health and Human Services Commission (HHSC) has issued Form 2076, Authorization to Release Medical Information, to facilitate the verification of medical needs for determining eligibility for services. This form is designed to be completed by individuals who need to authorize HHSC or a provider to access their health information from doctors, medical facilities, or other healthcare providers.

This authorization form serves as a crucial step in the process of determining an individual's eligibility for services provided by HHSC or its partners. By signing this form, the individual grants permission to release their medical information to authorized parties, ensuring that healthcare providers have access to necessary health records to deliver quality care. The form also includes provisions for witnesses to sign if the individual is unable to sign their name.

The Texas HHS Form 2076 emphasizes the importance of protecting personal health information in accordance with federal and state privacy regulations. Individuals are advised that authorizing release of their health information may no longer be protected by these regulations, but they can withdraw their permission in writing at any time unless action has already been taken based on their previous authorization.