Release

A release form or waiver allows one person or entity to hold harmless another party for an act, debt, liability, or any other type of exposure that may exist. Download the forms below in Adobe PDF and Microsoft Word (.doc).

Forms

Contractor’s Final Release and Waiver of Lien

This form is to be filed by  the contractor or supplier  who/which under Contract with the owner  performed  labor, or furnished  materials, services.  For and in consideration of the amounts  and sums received,  the contractor or supplier  waives,  discharges, and releases any and all liens, claims, and rights to liens against the  project or any funds needed for the construction of the owner’s project. For all other important details about the form,  read the entire form.

Final Release Final Waiver of Claims and Release of Rights

This form is to be filed by a corporation (contractor or supplier)  who/which under Contract with the principal contractor  performed  labor, or furnished  materials, services  in accordance  with the project’s Contract.   For and in consideration of the sums and  amounts received,  the contractor or supplier  waives, releases and relinquishes   any and all claims, rights or causes of action in equity or law.

Authorization for the Release of Information Under the Privacy Act

This form is to be completed by the applicant authorizing a U.S Consular Office  of the U.S.A to release information about herself/himself  to the individuals.  For the extent of the applicant’s  rights to self-privacy, read the form carefully.

1-800-Medicare Authorization to Disclose Personal Health Information

The 1-800-Medicare Authorization to disclose personal health information is a legal document which is used to advise Medicare of the person or persons you have selected to have access to your personal health information.

Medicare Subrogation Form

Medicare must have your written permission to give out your personal medical information. The applicant must complete this form and send to:  Medicare BCC, Written Authorization Dept. PO Box 1270, Lawrence, KS 66044

 

Photograph Copyright Release Form

Photograph Copyright Release Form.pdf Photograph Copyright Release Form.doc This form allows for a person that was previously photographed to have the pictures be released publicly. Must be signed by

Release of Lien Form

Release of Lien.pdf Release of Lien.doc This form authorizes the exoneration of a debt being held against a property. This form when signed by the creditor, releases the claim against the property.

Hipaa Medical Release Form

Hipaa Medical Release.pdf This form allows the release of a patient under the current HIPAA conditions.

Insurance Subrogation Form

Insurance Subrogation.pdf This form allows for your insurance company to verify that any person seeking payment for a caim is not receiving payments from any other insurance company.

Medicaid Subrogation Form

Medicaid Subrogation.pdf This form must be completed in order to receive assistance from Medicaid. Fill in this form and submit to the medicaid office nearest you.