Alabama Medicaid recipients may complete this form to provide authorization for the Agency to share their information with a third party. If there are questions regarding the form, contact the Medicaid Privacy Office by emailing privacyoffice@medicaid.alabama.gov.
|
|
| Form 703 Instructions (Alabama Power) |
Instructions on how to complete the Authorization for Disclosure of Health Information Form 703 (Alabama Power). |
| Form 703 |
This form authorizes Medicaid to disclose your health information. |