Attachment F - Authorization for Release of Information Form.pdf

This is an Authorization for Release of Information Form from the Alabama Medicaid Agency designed for bidders submitting proposals to render services for the Agency. The form authorizes the release of business information and records to the Alabama Medicaid Agency for the purpose of evaluating a bidder's ability to provide goods and services related to the Alabama Medicaid Eyewear Program contract opportunity. The authorization permits the Agency to access and review business records as part of the bid evaluation process.

The form stipulates that information obtained through this authorization may be used solely for evaluating the bidder's qualifications and capacity to perform under the contract. The Alabama Medicaid Agency agrees to maintain the confidentiality of all released information and will not disclose it to other parties without the bidder's consent, except where required by State or Federal statute or regulation. The form requires signature from the supplier or authorized representative, along with a witness signature and title, and must include the supplier's name.