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  • Authorization For Use Or Disclosure - Chi Franciscan ...

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I, HEREBY AUTHORIZE disclosure and/or inspection of PHI for: Patient or Personal Representative Name Patient Name xxx xx SSN (last four digits) DOB FROM THE FOLLOWING: o St. Joseph Medical Center.

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CHI was a nonprofit, faith-based health system formed, in 1996, through the consolidation of three Catholic health systems. It was one of the United States' largest healthcare systems. In February 2019, CHI merged with Dignity Health, forming CommonSpirit Health.

Virginia Mason Franciscan Health is the culmination of the integration of two highly regarded health systems, Virginia Mason and CHI Franciscan, both with a rich history of providing state-of-the-art health care to the Northwest.

A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

CommonSpirit Health, one of the nation's largest nonprofit health systems, is the parent company of CHI Franciscan.

Healthcare giant CommonSpirit Health finalized a deal to acquire Seattle-based Virginia Mason this week. Virginia Mason will combine with Tacoma, Washington-based CHI Franciscan to form an integrated health system to be known as Virginia Mason Franciscan Health.

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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