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These core elements include: The specific information that will be used or disclosed. The specific identifiers of the individuals(s) authorized to make the requested use or disclosure. The specific identification of any third parties who the covered entity may make the requested disclosure.
compliant HIPAA release form must, at the very least, contain the following information: A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.
Even though the parent did not consent to the treatment in this situation, the parent would be the child's personal representative under the HIPAA Privacy Rule.
I hereby authorize use or disclosure of protected health information about me as described below. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.
Generally, a parent or guardian of a minor child is regarded as what the HIPAA Privacy Rule calls the ?personal representative? of the minor child. Per the HIPAA Privacy Rule, a personal representative is authorized to exercise the HIPAA rights of the individual whom he or she represents, on that person's behalf.