TX HHS Form 2277. Client Information Release

The Texas Health and Human Services' Form 2277, Client Information Release, is a crucial document that enables individuals to authorize the release of their personal information to specific persons or agencies. This form helps solve the problem of limited service access by granting permission for the Area Agency on Aging (AAA) to share relevant health information with necessary parties.

This authorization form requires completion of Parts A, B, and C by the individual or personal representative. Key features include the release of all or part of the individual's information, which may contain protected health information. The form also outlines specific purposes for releasing information, such as assessing and meeting individual service needs. Additionally, it specifies the expiration event or date for the authorization.

The Form 2277 emphasizes the importance of understanding that once the authorization is granted, the AAA is not responsible for any redisclosure of the information by the recipient. Individuals can withdraw their permission in writing at any time, unless the AAA has already taken action based on their permission. It is essential to complete this form carefully and accurately to ensure proper release of information.

• This form is used when an individual needs to authorize the release of their personal information for service purposes.
• The form requires completion of Parts A, B, and C by the individual or personal representative.
• It outlines specific purposes for releasing information, such as assessing and meeting individual service needs.