This form authorizes the release of plaintiff's confidential medical records to plaintiff's attorney.
Alabama Authorization to Release Confidential Records
State:
Multi-State
Control #:
US-PI-0312
Format:
Word;
Rich Text
Instant download
Description
How to fill out Authorization To Release Confidential Records?
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FAQ
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.
HIPAA Authorization Defined A description of the PHI. The name of the person making the authorization. The name of the person or organization who is authorized to receive the PHI. A description of the purpose for the use or disclosure. An expiration date for the authorization.
A HIPAA authorization form, also known as a HIPAA release form, is a document that individual signs for their health provider before the entity may use or disclose their protected health information (PHI). HIPAA authorizes the sharing of PHI for the following purposes: Treatment. Payment.
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.
Starting in 2021, a new federal rule made it easier for patients and Medicaid recipients to access their medical records. Alabama Medicaid recipients and Alabama patients can view their health information from their smartphone or mobile device through a health application (app) of their choice.
What Information Must a HIPAA Authorization Contain to be Valid? A description of the specific information to be used or disclosed. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
It is permissible, based on the court's decision, to charge the statutory amount allowed by Alabama law - $1.00 per page for the first 25 pages, $0.50 for each page thereafter. However, you are not allowed to charge the search/retrieval fee of $5.00.
Records must be retained for at least seven years from the physician's (and/or other providers within the practice) last professional contact with the patient.
