Your personal health information is protected by law and cannot be shared between medical practices, insurance companies, etc. without your authorization. Use this form to authorize sharing or transfer of your protected health information between Bluegrass Allergy Care and another organization.
A copy of this form will be emailed to you so it can be signed. The authorization to release medical records is not complete without a signature. Patients age 18 and over must sign for release of their records. Legal representatives may also sign the authorization.
