Voluntary And Informed Consent For Disclosure Of Health Care Information {WKC-9488-E}

WKC-9488-E - VOLUNTARY AND INFORMED CONSENT FOR DISCLOSURE OF HEALTH CARE INFORMATION. This is a form to provide consent for release of medical information. The form is used to authorize health care providers to release an employee’s medical records and health information to parties involved in a worker’s compensation claim, including the employee’s employer, worker’s compensation insurer, or their representatives. This form ensures that medical information, which may relate to the employee’s alleged work injury, can be provided without the provider first determining its relevance to the claim. By signing this form, the employee voluntarily waives any legal privilege protecting these records and allows disclosure for the investigation, evaluation, preparation, or hearing of their worker’s compensation claim. The form covers physical health records, and optionally mental health, drug and alcohol treatment, and HIV/AIDS information. The consent is effective for two years, may be revoked in writing, and allows redisclosure to authorized parties, including insurers, the Department of Workforce Development, courts, attorneys, and experts involved in the claim. Completion of this form helps facilitate a timely investigation and processing of the worker’s compensation claim, although it is not mandatory. www.FormsWorkflow.com