The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Release Of Information Form Mental Health In Pennsylvania
Category:
State:
Multi-State
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
(1) Any minor who is fourteen years of age or older may consent on his or her own behalf to outpatient mental health examination and treatment, and the minor's parent's or legal guardian's consent shall not be necessary.
(1) A patient or his designee, including his attorney, shall have the right of access to all of his medical charts and records and to photocopy obtain photocopies of the same, without the use of a subpoena duces tecum, for his own use.
Section 25.213 - Medical records (a) A medical record shall be maintained for each patient, identifying the patient, the person making the entry, the date of each contact, pertinent clinical information, diagnoses, findings, laboratory results and other diagnostic, corrective or therapeutic procedures, including ...
The Personnel File Inspection Act provides that an employer shall, at reasonable times, upon an employee's request, permit the employee to inspect the employee's personnel file used to determine qualifications for employment, promotion, additional compensation, termination or disciplinary action.
Retention Requirements & Record Ownership In Pennsylvania, physicians must retain an adult patient's medical records for at least seven years from the last date of service. Requirements differ slightly for minor patients.
DISCIPLINARY CONSEQUENCES (ACT 26) A student with a weapon at school, at a school event, or traveling to or from school can be expelled for one year or more, with certain exceptions. The student does not have to use the weapon. It is enough to carry the weapon, keep it in a locker or book bag, or hold it for a friend.
Pennsylvania has the Mental Health Parity and Addiction Equity Act (MHPAEA) that requires mental health and substance use disorder parity, which means that your health insurance company is required by law to provide you with the same level of health insurance coverage for mental health and substance abuse disorder ...
§ 16.95. (a) A physician shall maintain medical records for patients which accurately, legibly and completely reflect the evaluation and treatment of the patient. The components of the records are not required to be maintained at a single location. Entries in the medical record shall be made in a timely manner.
(1) Any minor who is fourteen years of age or older may consent on his or her own behalf to outpatient mental health examination and treatment, and the minor's parent's or legal guardian's consent shall not be necessary.
More info
By signing this form, I understand that I am authorizing Penn Medicine to release information as described above. Please type your name to say it is OK to share your Health Information.I give my OK to share the information listed on this form. We will not release records if you submit an incomplete form. If you need assistance completing the form, please contact our office at . Instructions for Release of Medical Information​​ 1. Release of Information. Please complete the Authorization for Disclosure of Health Information Form in its entirety. Incomplete forms will be returned to the sender for completion. 2. Name: Date of Birth: Medical Record Number: Phone: (_____).
