Home > Forms Repository > Voluntary and Informed Consent for Disclosure of Health Care Information, WKC-9488-E

Voluntary and Informed Consent for Disclosure of Health Care Information

Document Number:  WKC-9488-E

Description:  This is a form to provide consent for release of medical information.

Comments:  This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word).  If you do not have Microsoft Word,  you can still use the WKC-9488-E version by printing a copy and then completing the form by hand.

Content Contact:  Don Martin

Document Attachments:

WKC-9488-E (English Electronic Version - Word/63 KB)

WKC-9488-H (Hmong Print Version - pdf/40 KB)

WKC-9488-S (Spanish Print Version - pdf/41 KB)

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