Limited Release Of Protected Medical Health Care Information {WCB-220-A}

WCB-220-A - LIMITED RELEASE OF PROTECTED MEDICAL/HEALTH CARE INFORMATION RELATED TO PSYCHOLOGICAL MATTERS. This form is used to grant authorization for the release of psychological treatment records related to a worker's compensation claim. The State of Maine Workers' Compensation Board requires this form to allow healthcare providers to release specific psychological treatment records to the employer or insurer involved in the worker's compensation case. The form allows the employee to specify whether they consent to the release of records limited to the date and description of injury, or all treatment records from the healthcare provider. It includes provisions about the timeframe for the release, the voluntary nature of signing the form, and the employee's rights regarding revocation or review of their records. The form ensures compliance with the Board's rules and protects the privacy of the employee's medical information. www.FormsWorkflow.com