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Michigan Forms

Academic Educational Authorization

AETNA Authorization (New)

AFLAC

Allegiance Health FKA Sparrow Hospital

Assurant Health (New)

BCBSM Authorization for PHI

Beaumont Health Authorization

Botsford Hospital Authorization Release PHI

Brighton Center For Recovery

Bronson Methodist Hospital

CIGNA

Core Institute Authorization

Covenant Healthcare

CVS Pharmacy PHI Release Authorization

Detroit Fire Department EMS Division HIPAA

Detroit Medical Center DMC

Employment Authorization

Financial Institution Authorization

Franciscan Health Michigan City

Hammond Henry Hospital

Harbor Behavioral Health

Henry Ford Behavioral Health Authorization

Henry Ford Health System

Henry Ford HS Psychotherapy Notes

Highland Park School District

Indiana University

Insurance Info

McLaren Macomb Authorization

McLaren Oakland Hospital Authorization

McLaren Oakland

MDCH Medical Marijuana Registry

MDHHS

Medical Employment Records (Michigan Only)

Medicare and Medicaid

MI Department of Natural Resources Request

MI Department of State Record Lookup Request

MI Driving Record

MI State Police Request Form (Not Authorization)

MI Tax Authorization

MI Unemployment Insurance Agency

MI Psychiatric Authorization

MI Social Services

MI Treasury

MSU Health Team

Oakland Psychological Clinic

Oaklawn Hospital

Oakwood Medical

Pharmacy Authorization

PIIM (Partners In Internal Medicine)

Promedica FKA Mercy Memorial Hospital

Quest Diagnostics

Social Security Administration Earnings Authorization

Social Security Disability (updated Nov 2016)

Social Services Info Authorization

St. Johns Providence Authorization

St. Johns Hospital Detroit MI

St. Joseph Mercy Ann Arbor MI

St. Joseph Mercy Health Ann Arbor MI

St. Joseph Mercy Health Behavioral Health

University of Michigan Health System Ann Arbor MI

VA Medical Record Authorization

Walgreens

Walmart Pharmacy

Wayne County Medical Examiner

William Beaumont Hospital Authorization

Workers' Compensation Release Authorization (Word)

Workers' Compensation Records Authorization (Word)

Workers' Compensation Injury Medical Authorization

 

For more information contact the U.S. Legal Support office nearest you.