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  • Permission To Verbally Discuss Protected Health Information With Family And Friends

Get Permission To Verbally Discuss Protected Health Information With Family And Friends

Llows you to tell us who we may talk with about your health care. This includes appointment and scheduling information, lab and test results, treatment information and billing information. How can I give others permission to get verbal information about me? Complete the Permission to Verbally Discuss Protected Health Information form on the reverse side of this page to let us know to whom we may speak about your information. Check the appropriate boxes to indicate what information we may discuss.

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Related content

Disclosures to Family and Friends | HHS.gov
Does the HIPAA Privacy Rule permit a doctor to discuss a patient's health status...
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Disclosures to Family and Friends | HHS.gov
Does the HIPAA Privacy Rule permit a doctor to discuss a patient's health status...
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MINOR CONSENT TO MEDICAL TREATMENT LAWS
minor child, the physician and surgeon shall disclose medical information concerning the...
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Related links form

CA MC 194 2007 CA MC 306 (SP) 2008 CA MH 224A - Los Angeles County 2009 CA MH 713 2015

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The consent form must be accompa- nied by a Privacy Notice; 2. HIPAA consent must be separate from the normal informed consent for treatment; 3. The consent must be in plain lan- guage and signed by the patient; and 4. The patient may revoke that consent at any time.

HIPAA Authorization Defined An authorization must be in writing, written in plain language, and must contain specific elements and statements to be valid. The specific elements and statements in a valid authorization are: Elements: A description of the PHI.

By completing the Authorization to Verbally Discuss Protected Health Information Form, it will allow us to talk about your medical care to those you have designated. This includes appointment and scheduling information, lab and test results, treatment information, and billing information.

You do NOT need to get written permission. They may agree verbally. Best practices require you to document that agreement in their patient record afterward.

As noted above, for permitted disclosures of health information, HIPAA does not require that a patient give written permission. Instead, clinicians are allowed to use a patient's verbal consent.

Under the Privacy Rule the patient must be given an “opportunity to agree or object” to the disclosure of PHI to someone else, even family members, but it does NOT have to be in writing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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