Authorization to Disclose Personal Health Information form

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https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf

Your Privacy Options

We take your privacy seriously. You can change the settings below to make sure you're comfortable with the ways we collect and use information while you're on Medicare.gov. For more information, please see our privacy notice.

Category	Description	Status
Advertising	We use digital advertising tools, such as web beacons, to track the effectiveness of our digital advertising outreach efforts. This helps us identify ads that are helpful to consumers and efficient for outreach. Selecting OFF will block this tracking.	On Off
Social Media	If you share our content on Facebook, Twitter, or other social media accounts, we may track what Medicare.gov content you share. This helps us improve our social media outreach. Selecting OFF will block this tracking.	On Off
Web Analytics	We use a variety of tools to count, track, and analyze visits to Medicare.gov. This helps us understand how people use the site and where we should make improvements. Selecting OFF will block this tracking.	On Off