TX HHS Form H2076. Authorization to Release Medical Information

The TX HHS Form H2076, Authorization to Release Medical Information, is a crucial document that helps facilitate the sharing of medical information between healthcare providers, Texas Health and Human Services (HHS), and other authorized parties. This form is typically completed by clients or patients who need to authorize the release of their medical records for purposes such as determining eligibility for services or treatment.

This authorization form requires the client's signature, which grants permission to HHS or a provider agency to contact healthcare providers, obtain copies of health information, and release it as indicated. The form also includes space for the client or personal representative to describe their authority to act on behalf of the client. Additionally, the form notes that if the person requesting the release of case information cannot sign their name, two witnesses must sign below.

Key features of this form include the requirement for client signature and authorization, as well as the need for witnesses in cases where the client is unable to sign. The form also emphasizes the importance of protecting personal health information in accordance with federal and state privacy regulations. By using this form, clients can ensure that their medical records are shared securely and efficiently.

• This form is used to authorize the release of medical information for purposes such as determining eligibility for services or treatment.
• The client's signature is required to grant permission for HHS or a provider agency to access health information.
• This form is typically completed by clients or patients who need to share their medical records with healthcare providers or other authorized parties.