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Authorization for Disclosure of Protected Health Information I hereby authorize CIGNA HealthCare *, its agents or subsidiaries to disclose the Protected Health Information (PHI) indicated below to.

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Related content

FORM IHS-810 - HHS.gov
Indian Health Service. AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH...
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Protected Health Information (HIPAA) - UCI Office...
Personal Health Information is used on the University of California HIPAA Authorization...
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Generally, PHI can be found in a wide variety of documents, forms, and communications such as prescriptions, doctor or clinic appointments, MRI or X-Ray results, blood tests, billing information, or records of communication with your doctors or healthcare treatment personnel.

In addition, organizations must provide a patient's protected health information to them if requested, preferably in an electronic PHI (ePHI) format.

ing to the HIPAA Journal, “PHI is any health information that can be tied to an individual.” This includes information used during the provision of healthcare, payment for healthcare, or for healthcare operations. ePHI is simply PHI stored electronically on a hard drive, server, thumb drive, or other devices.

Control and secure keys to locked files and areas. Do not leave keys in locks or in areas accessible to persons who do not have need for the stored PHI. Do not place documents containing PHI in trash bins. Promptly shred documents containing PHI when no longer needed, in ance with College procedures.

Medical Records and PHI should be stored out of sight of unauthorized individuals, and should be locked in a cabinet, room or building when not supervised or in use. Provide physical access control for offices/labs/classrooms through the following: Locked file cabinets, desks, closets or offices. Mechanical Keys.

All formats of PHI records are covered by HIPAA. These include (but are not limited to) spoken PHI, PHI written on paper, electronic PHI, and physical or digital images that could identify the subject of health information.

PHI is anything that can be used to identify an individual such as private information, facial images, fingerprints, and voiceprints. These can be associated with medical records, biological specimens, biometrics, data sets, as well as direct identifiers of the research subjects in clinical trials.

A HIPAA consent form is a legal document that authorizes covered entities to disclose protected health information that is not permitted by the HIPAA Privacy Rule. The form must be retained as proof that the authorization was obtained in writing to waive certain Privacy Rule restrictions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232