TX HHS Form 2076. Authorization to Release Medical Information

The TX HHS Form 2076, Authorization to Release Medical Information, is a crucial document that enables individuals to grant permission for healthcare providers or the Texas Health and Human Services Commission (HHSC) to access their medical records. This form helps solve the problem of verifying an individual's medical needs to determine eligibility for services.

This authorization form requires the individual's name, signature, and date, as well as information about the authorized doctors, medical facilities, or health care providers who will release the medical information. The form also includes a notice to the individual regarding their right to withdraw permission in writing if they change their mind. By signing this form, individuals give HHSC or a provider permission to contact their healthcare providers and obtain copies of their health information.

Key features of this form include:

• The requirement for the individual's signature and date
• The need for authorized doctors, medical facilities, or health care providers to release the medical information
• The notice to the individual regarding their right to withdraw permission in writing if they change their mind
• The expiration of this authorization form (date not specified)