List three items that must be included on a valid release of information form.

The individual's name and identifying information.
A specific and meaningful description of the information to be used or disclosed.
The name or other specific identification of the person, or class of persons, authorized to make the requested use or disclosure.
The name or other specific identification of the person, or class of persons, to whom the disclosure is to be made.
An expiration date or expiration event that relates to the individual, purpose of the use, or disclosure.
A statement of the individual's right to revoke the authorization, the exceptions to the right to revoke, and a description of the individual may revoke the authorization.
A statement that the information used or disclosed is subject to redisclosure and may lose its protected status.
The signature and date of the individual.
If the authorization is signed by the individual's personal representative, a description of the representative's authority to act for the individual.