Authorization To Release Medical Information {BWC-1224}

BWC-1224 - AUTHORIZATION TO RELEASE MEDICAL INFORMATION. Injured workers should use this form to authorize the release of medical records relative to their work-related injury(s). By signing this form, the injured worker authorizes medical providers who have rendered services relative to the injury to release information to BWC, the Industrial Commission, the employer, the managed care organization (MCO) or qualified health plan (QHP) and any authorized representatives. The form is intended to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), although BWC is exempt from HIPAA requirements. C-101. www.FormsWorkflow.com