Form 1022, Authorization to Disclose Information Including Protected Health Information for Referral to Another Agency/Organization

Texas Health and Human Services

This government document is issued by Texas Health and Human Services for use in Texas

Add to Favorites
File Details: PDF (152 KB)
Downloads: 5
Source
https://www.hhs.texas.gov/regulations/forms/1000-1999/form-1022-authorization-disclose-information-including-protected-health-information-referral-another

Have Questions About This Form?
Ask An Expert For Help:

Questions and comments are moderated. Minimum of 10 characters.

All questions and comments are moderated and publicly viewable. Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details.

Login or sign up to submit questions