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Blank Wisconsin Doc 1163 Form

The Wisconsin Doc 1163 form is an authorization document used to disclose non-health confidential information. This form is essential for individuals who need to share specific records with designated agencies or individuals, ensuring that personal data is handled appropriately. To begin the process of filling out this form, click the button below.

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Wisconsin Doc 1163 - Usage Guidelines

Completing the Wisconsin DOC-1163 form is an important step in authorizing the release of non-health confidential information. This form allows you to specify the details of the information you wish to disclose and to whom. Follow these steps to ensure accurate completion of the form.

  1. Obtain the Form: Access the DOC-1163 form from the Wisconsin Department of Corrections website or your local office.
  2. Fill in the Releasing Agency Information: Write the name, telephone number, fax number, address, city, state, and ZIP code of the individual or agency authorized to release the information.
  3. Provide Subject Information: Enter the name, address, identifying number (if applicable), date of birth, city, state, and ZIP code of the individual whose information is being released.
  4. Specify the Recipient: Fill in the name, telephone number, fax number, address, city, state, and ZIP code of the individual or agency that will receive the information.
  5. Check the Information Categories: Indicate which specific information you authorize for disclosure by checking the appropriate boxes. Options include education, employment, and other records.
  6. Identify Time Period: For each category selected, specify the time period of the records you wish to release.
  7. Complete Purpose Section: State the purpose of the disclosure for each category of information. This helps clarify why the information is being shared.
  8. Review Your Rights: Read the section regarding your rights with respect to the authorization. Ensure you understand your rights before proceeding.
  9. Sign the Authorization: Sign and date the form in the designated area. If applicable, have another person legally authorized to consent to disclosure also sign and date the form.
  10. Make Copies: Keep a copy of the completed form for your records. Distribute the original as instructed on the form.

Once the form is filled out and signed, it can be submitted to the appropriate agency. Ensure you keep a copy for your records, as this will help you track the authorization and any future communications regarding the information released.

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Dos and Don'ts

When filling out the Wisconsin Doc 1163 form, it is important to follow certain guidelines to ensure the process goes smoothly. Below is a list of things to do and avoid.

  • Do read the entire form carefully before starting to fill it out.
  • Do provide accurate information for all fields, including names, addresses, and dates.
  • Do check the appropriate boxes for the specific information you are authorizing for disclosure.
  • Do sign and date the form where indicated to validate your authorization.
  • Don't leave any required fields blank; this may delay processing.
  • Don't use this form for health-related information; use the DOC-1163A instead.
  • Don't forget to keep a copy of the signed authorization for your records.

Common mistakes

Filling out the Wisconsin Doc 1163 form can be straightforward, but many people make common mistakes that can delay the process. One major error is failing to provide complete information about the individual or agency releasing the information. It’s essential to include the full name, address, and contact details. Incomplete sections can lead to confusion and hinder the release of necessary records.

Another frequent mistake is not checking the appropriate boxes for the specific information authorized for disclosure. The form has clear categories, and it’s important to select all that apply. Omitting a relevant category can result in missing information that may be crucial for the intended purpose.

Many individuals also overlook the expiration date for the authorization. It’s vital to specify when the authorization will expire. If this step is skipped, the authorization may default to one year, which may not align with the individual’s needs.

Some people mistakenly assume that their signature alone is sufficient. However, it’s important to ensure that all required signatures are included. This includes the signature of the individual subject to the record and any other legally authorized person. Missing signatures can render the authorization invalid.

Additionally, failing to identify the time period of records can create issues. Whether it’s for education or employment records, specifying the time frame helps clarify what information is being requested. Without this detail, the request may be too broad or vague.

Another common error is misunderstanding the implications of re-disclosure. Many individuals do not realize that if they authorize the release of information to someone not covered by federal or state laws, that information may not remain confidential. Being aware of this can help individuals make more informed decisions.

Lastly, people often forget to keep a copy of the signed authorization for their records. Having a copy can be beneficial for future reference and ensures that the individual has proof of what was authorized. Keeping track of this document can help avoid misunderstandings down the line.

Documents used along the form

The Wisconsin DOC-1163 form is an essential document used for the authorization of non-health confidential information disclosure. Along with this form, several other documents play a vital role in ensuring proper handling of information. Below is a list of related forms and documents that are often used in conjunction with the DOC-1163.

  • DOC-1163A: This form is specifically for the authorization of disclosure of protected health information. It is used when health-related records need to be shared, ensuring compliance with federal regulations.
  • DOC-1164: This document is utilized for requesting access to educational records. It outlines the process for individuals seeking to review their educational history.
  • Homeschool Letter of Intent Form: To notify the school district of your intent to educate your child at home, you can find more information on the essential steps for completing the Homeschool Letter of Intent.
  • DOC-1165: This form is for the release of employment records. It allows individuals to authorize the sharing of their job performance evaluations and other employment-related information.
  • DOC-1166: This document is used for the release of social service records. It facilitates the sharing of information related to social services provided to individuals.
  • DOC-1167: This form is designed for the release of criminal justice records. It permits the disclosure of information regarding an individual’s interactions with the criminal justice system.
  • DOC-1168: This document is used for the consent to share substance abuse treatment records. It ensures that sensitive information regarding treatment is handled appropriately.
  • DOC-1169: This form is for authorizing the release of mental health records. It is essential for individuals who wish to share their mental health history with specific agencies.
  • DOC-1170: This document is a general consent form for the release of personal information. It can be used in various contexts where personal data needs to be shared.
  • DOC-1171: This form is specifically for the two-way release of information. It allows both parties to share information with each other, ensuring mutual consent.
  • DOC-1172: This document is for the release of educational assessments. It provides a way to share results from evaluations related to educational performance.

Understanding these documents is crucial for anyone navigating the process of information disclosure in Wisconsin. Each form serves a specific purpose and ensures that the rights of individuals are respected while facilitating the necessary sharing of information.