[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-283687-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-283687-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","sample-medical-authorization-forms-for-adult-patients-with-developmental-disabilities","Sample Medical Authorization Forms - for adult patients with developmental disabilities","","Sample Medical Authorization Forms compile multiple consent and authorization documents for adult patients with developmental disabilities, designed for use with health care providers in Missouri. The set includes HIPAA release of information and records, designation of ADA support persons, patient representatives, and health care agents for POA use, plus power of attorney and advance directives. Additional materials address complaints to DHSS regarding hospitalization, supported decision-making, a health care passport, and a certificate confirming understanding and voluntariness. Educational-only guidance with a request to consult an attorney for legal advice.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/sample-medical-authorization-forms-for-adult-patients-with-developmental-disabilities/283687/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/sample-medical-authorization-forms-for-adult-patients-with-developmental-disabilities/283687.png","ImageObject",442,249,{"name":42,"@type":43},"Chumphorn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What are these sample medical authorization forms used for?","Question",{"text":63,"@type":64},"They are used to support consent and authorization for health care decisions for adult patients with developmental disabilities when working with health care providers in Missouri.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which forms related to HIPAA and privacy are included?",{"text":68,"@type":64},"The set includes a HIPAA release of information and records form to authorize sharing of medical information.",{"name":70,"@type":61,"acceptedAnswer":71},"Do these forms provide legal advice?",{"text":72,"@type":64},"No. The forms are for educational purposes only, can be modified as needed, and legal advice requires consulting an attorney.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},283687,1790985255,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","Sample Medical Authorization Forms  \nfor adult patients with developmental disabilities  \n(for use with health care providers in Missouri)  \nComplied by  \nAlternatives to Guardianship Project  \n1. Designation of ADA Support Person-Link [https://alternativestoguardianship.com/forms/1-designate-support-person.pdf](https://alternativestoguardianship.com/forms/1-designate-support-person.pdf)  \n[2](2). HIPAA Release of Information and Records-Link [https://alternativestoguardianship.com/forms/2-hipaa-form-fillable.pdf](https://alternativestoguardianship.com/forms/2-hipaa-form-fillable.pdf)  \n[3](3). Designation of Patient Representative-Link  \n[https://alternativestoguardianship.com/forms/3-designate-representative.pdf](https://alternativestoguardianship.com/forms/3-designate-representative.pdf)  \n[4](4). Designation of Health Care Agent (POA Only) -Link [https://alternativestoguardianship.com/forms/4-designate-health-care-agent.pdf](https://alternativestoguardianship.com/forms/4-designate-health-care-agent.pdf)  \n[5](5). Power of Attorney and Advance Directives-Link [https://alternativestoguardianship.com/forms/5-dpa-fillable-with-instructions.pdf](https://alternativestoguardianship.com/forms/5-dpa-fillable-with-instructions.pdf)  \n[6](6). Complaint to DHSS Re Hospital-Link  \n[https://alternativestoguardianship.com/forms/6-complaint-vs-hospital-dhss.pdf](https://alternativestoguardianship.com/forms/6-complaint-vs-hospital-dhss.pdf)  \n[7](7). Supported Decision-Making Form (MoP&A)– Life Course Tools [https://alternativestoguardianship.com/forms/7-SDMA-p&a-form.pdf](https://alternativestoguardianship.com/forms/7-SDMA-p&a-form.pdf)  \n[8](8). Health Care Passport-Link  \n[https://alternativestoguardianship.com/forms/8-health-care-passport.pdf](https://alternativestoguardianship.com/forms/8-health-care-passport.pdf)  \n[9](9). Certificate of Understanding and Voluntariness-Link [https://alternativestoguardianship.com/certificate-understanding.pdf](https://alternativestoguardianship.com/certificate-understanding.pdf)  \nThis is not intended as legal advice for a specific case. These forms were developed for educational purposes only. They can be modified by patients and families as necessary for a specific situation. Consult an attorney if legal advice is needed.","cbCaippypbcmHGjR","https://ap.wps.com/l/cbCaippypbcmHGjR","pdf",42223,"English","# Included Forms\n## ADA Support Person Designation\n## HIPAA Release of Information and Records\n## Patient Representative Designation\n## Health Care Agent (POA Only)\n## Power of Attorney and Advance Directives\n## Complaint to DHSS Re Hospital\n## Supported Decision-Making Form (MoP&A)\n## Health Care Passport\n## Certificate of Understanding and Voluntariness","[{\"question\":\"What are these sample medical authorization forms used for?\",\"answer\":\"They are used to support consent and authorization for health care decisions for adult patients with developmental disabilities when working with health care providers in Missouri.\"},{\"question\":\"Which forms related to HIPAA and privacy are included?\",\"answer\":\"The set includes a HIPAA release of information and records form to authorize sharing of medical information.\"},{\"question\":\"Do these forms provide legal advice?\",\"answer\":\"No. The forms are for educational purposes only, can be modified as needed, and legal advice requires consulting an attorney.\"}]","Sample Medical Authorization Forms - for adult patients with developmental disabilities | PDF",1789617259]