PHI Hospital or Healthcare Provider

Ascension Michigan Authorization to Release PHI

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Aspirus- MI & WI Authorization for Disclosure of PHI Authorization Form

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Associates in Psychiatry- Auth- MUST Pick Provider, Sign W-In 30, Wet Sig & Be Notarized

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Athletico Physical Therapy- Authorization to Release Medical Information

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ATI Physical Therapy- Authorization for Use Disclosure Form

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Attestation for a Requested Use of Disclosure of PHI- Attorney Signs

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Authorization For the Release and Disclosure of Psychotherapy NotesAuthorization For the Release and Disclosure of Psychotherapy Notes

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Baraga County Memorial Hospital- Authorization to Release PH

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Bronson Hospital- Authorization for Use or Disclosure of Health Information

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Cleveland Clinic- Medical Record Release Form

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Corewell Health- fka Spectrum, Beaumont & Lakeland- Authorization to Release PHI

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Costco Authorization to Release PHI

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Covenant HealthCare- Authorization to Disclose Health Information

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Emergent Health- Monroe- Huron Valley- Jackson Comm- Lenawee- Albion & LifeCare Ambulance

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Family Health Center- Authorization-for-Disclosure-of-Health-Information

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General Medical Authorization Form- Blank- No Language

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General Medical Authorization Form- With Language

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Harbor Oaks Hospital- Authorization for ROI

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Henry Ford Health System- Authorization to Release Medical Information

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Holland Hospital Authorization to Release Records

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Hope Network Authorization for the Release of PHI

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Hurley Medical Center- Behavioral Health Records Authorization

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IHA- Release-of-Information-Authorization-Form

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IINN- Insight Institute of Neurosurgery & Neuroscience Authorization to Release PHI

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Lake Huron Medical Center- Authorization for Use or Disclosure of Health Information

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Lakeland Health Authorization for Release of Information

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Mayo Clinic- Authorization to Release PHI

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McLaren Health System- Authorization to Release Information

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Memorial Healthcare Authorization To Use Or Disclose PHI

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Mercy Health- Defiance Hospital- OHIO- Authorization to Release PHI

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Meridian Health- Authorization to Use and Disclose Health Information

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Metro Health Authorization Form to Release PHI

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MI DHHS Form 5515 Consent to Share Behavioral Health Information

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Michigan Department of Corrections- Medical Release Form- CHJ-121

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Michigan DHHS Form 5515 Consent to Share Behavioral Health Information

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Michigan Medicine- Authorization to Release PHI

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MidMichigan Health- Authorization to Release PHI

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MSU HealthTeam- Authorization for Release of Medical Records

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Munson Healthcare- Authorization to Release PHI

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New Oakland Family Centers Authorization

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Oakland Psychological Clinic- Authorization to Release Confidential Information

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Oaklawn Hospital- Authorization for Disclosure of Health Records

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Pine Rest Authorization for Release & Disclosure of PHI

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Priority Health- Authorization for Release PHI

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ProMedica- Authorization to Disclose Health Info

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Quest Diagnostics- Authorization to Release PHI

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Scheurer Health- Authorization for Release of PHI

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The City of Detroit- Fire Department- DFD- EMS Division HIPAA Authorization to Disclose PHI

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The Core Institute- Authorization to Disclose Health Information

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Total Health Care- Release of PHI

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Trinity Health- Grand Haven fka North Ottowa Community Health System- Authorization

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Trinity Health- IHA Medical Group- Authorization to Release Medical Records

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Unsigned Ascension- Genesys Hospital- Authorization

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UP Health System- Portage Hospital- Release of Info Authorization Form

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VRC- HIPAA Authorization to Release Health Information

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Wayne State University Physicians Group- Release PHI

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