Download Authorization Templates

  1. HIPAA Compliant Patient Authorization
  2. Memorial Hermann HIPAA Compliant Patient Authorization
  3. VA Medical Authorization
  4. Tax Return Authorization
  5. Military Records
  6. Social Security Earnings
  7. Social Security Disability Records
  8. *TWCC 153 Form (This form is used when you have the Claim #)
  9. *TWCC 155 Form (This form is used when you do NOT have the Claim #)
  10. Authorization To Disclose Protected Health Information

 

*Note: This form is NOT a request to be fulfilled by Nell McCallum & Associates. You must request these records directly from the law firm. The TWCC does not accept third-party request.