Florida Authorization for Use and / or Disclosure of Protected Health Information

State:
Multi-State
Control #:
US-178EM
Format:
Word; 
Rich Text
Instant download

Description

This form allows an employee to authorize the types of medical information to be disclosed by human resources.

The Florida Authorization for Use and/or Disclosure of Protected Health Information is a legal document that allows individuals to grant permission or provide consent for the use or disclosure of their protected health information (PHI) in the state of Florida. This authorization is a critical component under the Health Insurance Portability and Accountability Act (HIPAA) and the Florida Health Information Privacy Act (SHIPS). Protected health information refers to any individually identifiable health information that is created or received by a healthcare provider, health plan, or healthcare clearinghouse. It can include details about an individual's past, present, or future physical or mental health conditions, healthcare treatments, or payment information related to healthcare services. The Florida Authorization for Use and/or Disclosure of Protected Health Information ensures that individuals have control over who can access their personal health information. It allows them to make informed decisions about sharing their information with specific individuals or entities involved in their care, research, legal matters, or other purposes allowed by law. There are different types of Florida Authorization for Use and/or Disclosure of Protected Health Information depending on the specific purposes for which the authorization is sought. Some common types include: 1. General Authorization: This type of authorization grants consent for the use or disclosure of the individual's protected health information for a range of purposes specified by the individual. It is often used in routine healthcare settings, such as hospitals or clinics. 2. Research Authorization: This specific authorization allows the use or disclosure of protected health information for research purposes. Researchers must abide by strict protocols to ensure the privacy and confidentiality of participants' health information. 3. Psychotherapy Notes Authorization: Psychotherapy notes are a distinct category of protected health information. This authorization specifically grants consent for the use or disclosure of psychotherapy notes, which are recorded by a mental health professional during a counseling session. 4. Marketing Authorization: If a healthcare provider or organization wishes to use an individual's protected health information for marketing purposes, they need to obtain a specific marketing authorization. This ensures the individual's consent and allows them to opt-out if they do not wish to receive marketing communications. It is important to note that the Florida Authorization for Use and/or Disclosure of Protected Health Information allows individuals to set limitations or restrictions on who can access their health information, the specific information involved, and the duration for which the authorization is valid. This document empowers individuals to maintain control over their health information, safeguarding their privacy and ensuring confidentiality in healthcare settings.

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FAQ

Marketing Activities: A covered entity must obtain an individual's authorization prior to using or disclosing PHI for marketing activities. Marketing is considered any message or statement to the public in an effort to get them to use or seek more information about a product or service.

Under the HIPAA Privacy Rule, a covered entity must disclose protected health information in only two situations: (a) to individuals (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information; and (b) to the Department of Health

Valid HIPAA Authorizations: A ChecklistNo Compound Authorizations. The authorization may not be combined with any other document such as a consent for treatment.Core Elements.Required Statements.Marketing or Sale of PHI.Completed in Full.Written in Plain Language.Give the Patient a Copy.Retain the Authorization.

The HIPAA Privacy Rule requires that an individual provide signed authorization to a covered entity, before the entity may use or disclose certain protected health information (PHI).

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

What are two required elements of an authorization needed to disclose PHI? Response Feedback: All authorizations to disclose PHI must have an expiration date and provide an avenue for the patient to revoke his or her authorization. What does the term "Disclosure" mean?

We may disclose your PHI for the following government functions: (1) Military and veterans activities, including information relating to armed forces personnel for the execution of military missions, separation or discharge from military services, veterans benefits, and foreign military personnel; (2) National security

A patient authorization is not required for disclosure of PHI between Covered Entities if the disclosure is needed for purposes of treatment or payment or for healthcare operations. You may disclose the PHI as long as you receive a request in writing.

More info

Rather, the mere ?use? of protected health information underdrawn to cover the entire range of uses or disclosures for which a consent ... Include the following information about the member whose protected information is being disclosed: 1. First and last name. 2. Date of birth. 3. Health Plan ID ...1 pageMissing: Florida ? Must include: Florida Include the following information about the member whose protected information is being disclosed: 1. First and last name. 2. Date of birth. 3. Health Plan ID ...Florida International University's (FIU) Health Insurance Portability andthe use or disclosure of Protected Health Information (PHI) on ...16 pages ? Florida International University's (FIU) Health Insurance Portability andthe use or disclosure of Protected Health Information (PHI) on ... Releasing medical records without a HIPAA authorization form is a HIPAAto use and disclose individually identifiable protected health information ... PURPOSE: I authorize CLEVELAND CLINIC FLORIDA to use or disclose my health information (including the highly confidential I selected above, if any) during ... Use the Consent for Use and Disclosure form if you want to give someone else, such as a family member or care giver, access to your protected health ... The UCSF HIPAA authorization form is also the correct form to use for researchAuthorization to Disclose Protected Health Information (PHI). The HIPAA Privacy Rule requires that an individual provide signed authorization to a covered entity, before the entity may use or disclose ... Of Protected Health InformationWrite dates below:This authorization allows UF Health to use and disclose (release) certain PHI, which includes ...1 page of Protected Health InformationWrite dates below:This authorization allows UF Health to use and disclose (release) certain PHI, which includes ... A copy of a Power of Attorney or other legal document must be on file at AmeriHealth Caritas Florida or submitted with this form.) Printed Name of Personal ...5 pages A copy of a Power of Attorney or other legal document must be on file at AmeriHealth Caritas Florida or submitted with this form.) Printed Name of Personal ...

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Florida Authorization for Use and / or Disclosure of Protected Health Information