This is a very (overly) broad form authorizing any information for you and for your dependents to be shared with your employer, your insurance company, and the company that administers your insurance plan (processes your claims, authorizes services, etc).

I doubt very much that it is HIPAA compliant because it is too broad and includes medical and non-medical categories.
http://www.hhs.gov/hipaafaq/use/index.html

and a good sample is available here: http://www.fitzharrisinsurance.com/f...-info-form.php

You do not have to use the form as printed. You can revise it and include the names of those who you are authorizing to release information as well as the names (company, doctor, hospital, etc) of those who may receive this information. You can also limit the information to the most specific information the requester needs. You can cross out, write in, or make changes in some other way. I would not sign until I was comfortable that the information is needed *at this time*, and is necessary *to making decisions about treatment*. There is nothing wrong with refusing to release information either.
Much of the information could be provided verbally during the course of treatment. If some kind of verification is being sought, the reason for the verification needs to be clear to you and acceptable to you.