Use this page to find authorizations and release forms required to gather client records from a variety of sources. Most of the links below will take you to the listed agency’s own forms webpage, where you can find the agency’s most recent versions of their required forms. Other links will open forms we’ve collected from agencies that don’t post them on their websites (last collected in October 2022; we’ll update periodically, but please let us know if you learn that a form is outdated). When gathering records from medical and mental-health providers that don’t offer their own forms, we suggest using this general HIPAA-compliant form.
Federal Agencies
Federal Bureau of Prisons Authorization for Release of Medical Information
BOP Form BP-A0192, Release of Information Consent
DOJ Form 361, Certification of Identity
Internal Revenue Service Form 4506, Request for Copy of Tax Return
Social Security Agency (various forms, including SSA-3288 and SSA-3288-SP, Consent for Release of Information in English and Spanish; and SSA-7050-F4, Request for Social Security Earnings Information)
U.S. Dept. of Veterans Affairs (VA Form 10-5345, Request for and Authorization to Release Health Information to third party)
U.S. General Services Administration (Standard Form 180, Request Pertaining to Military Records)
State Agencies (KS & MO)
Kansas Dept. for Children and Families (formerly SRS) (forms and instructions for requesting various records)
Kansas Dept. of Corrections (VitalCore) Authorization for Release of Healthcare Information (use along with general KDOC consent below)
Kansas Dept. of Corrections - Spanish (VitalCore) Authorization for Release of Healthcare Information (Spanish) (use along with general KDOC consent below)
Kansas Dept. of Corrections Consent to Release of Confidential Information
Kansas Dept. of Labor Request for Disclosure of Tax/Benefit Information
Kansas Dept. of Revenue (various records-request forms, including for vehicle records and tax documents)
Missouri Dept. of Social Services (various forms in English and Spanish, including CD-98, Authorization for Release of NON-Medical Records By/To Children’s Division; and SS-6, Authorization for Release of Medical/Health Information)
Missouri Dept. of Social Services (HIPAA-compliant privacy forms in English and Spanish, including MO866-4451, Individual’s Request for Access to Protected Health Information; and MO886-4596, Authorization for Disclosure of Confidential Information
Healthcare Providers
This list includes addiction and mental-health treatment.