General Release Of Medical Health Care Information {WCB-220}

WCB-220 - GENERAL RELEASE OF MEDICAL/HEALTH CARE INFORMATION. This form is used by the State of Maine Workers’ Compensation Board to authorize the disclosure of an employee’s medical records in relation to a workers’ compensation claim. It allows an employee to grant permission to their health care providers to release written records—specifically those related to the diagnosis, treatment, and care of specified body parts or medical conditions—to an employer, insurer, or their representative. The form emphasizes that the release does not include oral communications or information related to psychological issues, substance use disorders, HIV/AIDS, or sexually transmitted diseases unless explicitly authorized. Employees are advised they have 14 days to return the completed form and are encouraged to seek assistance if they do not understand it. The authorization is voluntary but necessary for claim evaluation; failure to sign may result in a claim denial. The form also clarifies that the authorization is revocable in writing and outlines redisclosure limitations. It must be submitted using the authorized WCB format, and it remains valid for 30 months from the signature date. www.FormsWorkflow.com