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, we are providing a PDF (WKC-9488) which you can print and complete by hand.

Content Contact:  Don Martin

Document Attachments:

WKC-9488-E (English Electronic Version - Word/64 KB)

WKC-9488 (English Print Version - pdf/46 KB)

WKC-9488-E-H (Hmong Electronic Version - Word/69 KB)

WKC-9488-H (Hmong Print Version - pdf/42 KB)

WKC-9488-E-S (Spanish Electronic Version - Word/64 KB)

WKC-9488-S (Spanish Print Version - pdf/38 KB)

***Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

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