This form authorizes the release of plaintiff's confidential medical records to plaintiff's attorney.
Connecticut 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
A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.
Florida law requires patient authorization for disclosure of some sensitive health data with certain exceptions in medical emergencies. An authorization form can be used by a patient or his/her authorized legal representative to authorize a healthcare provider to obtain the patient's records from another provider.
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.
A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.
A health care provider may disclose a patient's PHI for treatment purposes without having to obtain the authorization of the individual. Treatment includes the coordination or management of health care by a health care provider with a third party.
These core elements include: The specific information that will be used or disclosed. The specific identifiers of the individuals(s) authorized to make the requested use or disclosure. The specific identification of any third parties who the covered entity may make the requested disclosure.
