Colorado Permission Form for Releasing Information - Short Form
Description
How to fill out Permission Form For Releasing Information - Short Form?
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FAQ
Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.
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.
Authorization to Release InformationThe enclosed Authorization form is required in order to allow your Health Plan to release protected health information to another person or organization.
(ROI=Release of Information) A valid release of information form signed by a patient that authorizes the provider to release patient-specific information to persons not otherwise authorized to receive it.
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.
A release of information (ROI) department or division is found in the majority of hospitals. In the United States, HIPAA and state guidelines strongly direct the rules and regulations of patient information.
You may disclose the PHI as long as you receive a request in writing. The written request must contain: the covered entity's name, the patient's name, the date of the event/time of treatment, and the reason for the request.
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.
