TX HHS Form 2870. Permission to Disclose Protected Health and Other Confidential Information

TX HHS Form 2870: Permission to Disclose Protected Health and Other Confidential Information

This form is used to obtain permission from individuals to disclose their protected health information and other confidential data. It should be completed when an individual wants to authorize the release of their personal health records, educational information, or other relevant details to specific persons or organizations.

The form requires the individual's name, date of birth, and Social Security number (last four digits), as well as alternative contact information such as phone numbers and email addresses. The individual must also acknowledge that they have been informed about the purposes for which their protected health information will be used, including service plan development and other agency purposes.

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