College Station Independent School District

Success, Each Life...Each Day...Each Hour

HIPPA Form

AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION TO and FROM SCHOOL DISTRICTS

Completion of this document authorizes the disclosure and/or use of individually identifiable health information, as set forth below, consistent with Federal laws (including HIPAA) concerning the privacy of such information. Failure to provide all information requested may invalidate this authorization.

Please download the Entire HIPPA form by clicking the link below.

HIPAA Form

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