This is a multi-purpose form that informs the student-athlete of the inherent risk associated with participating in any athletic activities within the intercollegiate athletic department at an NCAA member institution. The subsequent sections allow the sports medicine staff to evaluate and treat any injury that might occur during an intercollegiate activity as well as allowing the sports medicine department to disclose information about those injuries to the individuals listed on the form and only those people. This form also includes an NCAA HIPAA form that allows the NCAA member institution to keep medical file on a secure server at the NCAA Headquarters as well as allows the NCAA to perform random drug testing to any student-athlete.
General Consent To Release Information Form
State:
Multi-State
Control #:
US-01717BG
Format:
Word;
Rich Text
Instant download
Description
Free preview
How to fill out Sports Medicine General Pre-Participation Form, Assumption Of Risk, Consent To Receive Medical Care, And HIPAA Release?
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FAQ
The core elements of a valid authorization include:A meaningful description of the information to be disclosed.The name of the individual or the name of the person authorized to make the requested disclosure.The name or other identification of the recipient of the information.More items...
By signing an authorization to release information, a party is consenting to provide another party with access to otherwise confidential information or records about an individual. However, signing a release doesn't mean the complete loss of confidentiality because most authorization forms are subject to limitations.
To put it simply, an interview consent form states the interviewee understands their words will be used in publications, while a video release form seeks permission from the subject to use their image, audio, and dialogue in publications.
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. An expiration date or expiration event when consent to use/disclose the information is withdrawn.
Elements of a release formPatient information. Naturally, the release should require the patient's information so it's clear who the form refers to.Receiving party's information.Information to be shared.Purpose of the release.Expiration of authorization.Disclaimers.Date and signature.