Medical Authorization Form To Release Records
Description
How to fill out Authorization For Use And / Or Disclosure Of Protected Health Information?
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FAQ
What information is included in a Medical Records Release Form?The patient or their representative.The organization who holds the records.The organization or individual requesting access.The period of duration for the release.
The patient's legal name, date of birth, gender, Social Security number, address, telephone number, guarantor, subscriber, or next-of-kin are key identifying elements that assist in establishing the proper individual.
You should specify so that your doctor knows what to release. If you want to release everything, then include this language: "I authorize the release of my complete health history (including all information related to HIV or AIDS, mental health care, communicable diseases, or treatment of alcohol and drug abuse)."
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
The physician should ask the patient to sign a written authorization to release this nontherapeutic information. The written permission should be dated, state to whom the information is to be released, which information may be passed on to that party, and when the permission to obtain information expires.