Arkansas Authorization to Use or Disclose Protected Health Information

State:
Multi-State
Control #:
US-3580
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to consent to the use or disclosure of protected health information as described within. The individual also indicates the acknowledgment of his or her rights regarding consent to the use and disclosure of the information.
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FAQ

A violation is an unauthorized disclosure that results in the conclusion there is a low probability of compromise to the PHI. If this low risk is determined and supported by the Risk Assessment, reporting the incident to the OCR and the involved patient is deemed to be unnecessary.

Health information such as diagnoses, treatment information, medical test results, and prescription information are considered protected health information under HIPAA, as are national identification numbers and demographic information such as birth dates, gender, ethnicity, and contact and emergency contact

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the

Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

A breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information.

Under HIPAA, a breach is defined as the unauthorized acquisition, access, use or disclosure of protected health information (PHI) which compromises the security or privacy of such information.

Health care providers may disclose the necessary protected health information to anyone who is in a position to prevent or lessen the threatened harm, including family, friends, caregivers, and law enforcement, without a patient's permission.

A HIPAA authorization is a detailed document in which specific uses and disclosures of protected health are explained in full. By signing the authorization, an individual is giving consent to have their health information used or disclosed for the reasons stated on the authorization.

More generally, HIPAA allows the release of information without the patient's authorization when, in the medical care providers' best judgment, it is in the patient's interest. Despite this language, medical care providers are very reluctant to release information unless it is clearly allowed by HIPAA.

Generally speaking, covered entities may disclose PHI to anyone a patient wants. They may also use or disclose PHI to notify a family member, personal representative, or someone responsible for the patient's care of the patient's location, general condition, or death.

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Arkansas Authorization to Use or Disclose Protected Health Information