Florida Authorization for Release of Information
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How to fill out Authorization For Release Of Information?
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FAQ
General Authorizations: In accordance with §164.508 of the privacy rule, an authorization for the disclosure of health information may be combined with another authorization. For example, a patient may request lab results be disclosed to two different family members (living in separate residences) on the same form.
HIPAA authorization is consent obtained from a patient or health plan member that permits a covered entity or business associate to use or disclose PHI to an individual/entity for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.
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.
Your authorization allows the Health Plan (your health insurance carrier or HMO) to release your protected health information to a person or organization that you choose.
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.
This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows the Health Plan (your health insurance carrier or HMO) to release your protected health information to a person or organization that you choose.
Generally, an authorization provides the authority for a doctor's release of PHI for specified purposes, which are generally other than treatment, payment, or healthcare operations, or, to disclose protected health information to a third party specified by the individual.
Q: How long does an authorization remain valid? A: It remains valid until the expiration date/event, unless the patient revokes it beforehand in writing.
Consent to Release InformationThe name of the person or entity authorized to make the request (usually the patient)The complete name of the person or entity to receive the protected health information (PHI)A specific description of the information to be used or disclosed, including the dates of service.More items...
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.More items...
