Completing this form allows Advantage Point Legal Services to release protected records and information belonging to the consenting individual.
Consent for Release of Information – Completing and submitting this form gives the Social Security Administration the right to release information about the consenting person to a specified third party.
Request for Copy of Tax Return – Completing and signing this form gives the IRS permission to release the tax and income information reported on the consenting person’s tax returns for a specified year or period.
Completing this form gives Blue Cross Blue Shield of Michigan permission to disclose protected health information of the consenting individual to a specified third party.
Authorization for Use and Disclosure of Psychotherapy Notes – Completing this form gives Blue Cross Blue Shield of Michigan permission to disclose psychotherapy notes to a specified third party.
Completing this form gives permission to the Centers for Medicare & Medicaid Services (CMS) to release information related to an injury, illness, and/or settlement of the consenting individual to a specified third party.
Completing this form allows the Medical Mobile Response INC to release requested PHI of the consenting individual to a specified third party.
Request for record lookup of driving information, including driving records, personal identification card information, and vehicle registration or title information.
Request and Consent for Disclosure of Tax Return and Tax Return Information – Completing this form allows the Michigan Department of Treasury to release the tax return and tax return information of the consenting individual to a third party.
Request Pertaining to Military Records – Complete this form to request the lookup of military records, including personal records, military human resource records, official military personnel file, and service treatment records.
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