Guam Request for an Individuals Health Information

State:
Multi-State
Control #:
US-3577
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to request access to his or her protected health information. The individual's rights regarding this access are also acknowledged by the individual.

How to fill out Request For An Individuals Health Information?

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FAQ

Medicaid Overview Guam became a territory in 1950 and its Medicaid program was established in 1975. It is a 100% fee-for-service delivery system with two hospitals currently servicing the territory.

Medicaid and Medicare programs are available on Guam. There is also a locally-funded Medically Indigent Program (MIP) designed to pay for medical expenses of low-income families without other health insurance. Those who don't qualify for assistance may opt for private insurance.

The following are the new Guam Medicaid poverty level income guidelines: Household size: 1 - Monthly gross income: $1,595. Household size: 2 - Monthly gross income: $2,156. Household size: 3 - Monthly gross income: $2,715.

It applies to everybody in the United States, and with regard to the security and privacy of health information in our country, there is no more important resource than HIPAA.

But HIPAA affects a great number of people other than healthcare providers. Employers that offer group health plans and any business or individual that provides services to physicians, healthcare providers, hospitals and insurance companies may also be affected by HIPAA.

In Guam, the HIPAA Privacy Rule sets most of the standards that Guam health care providers must follow when they handle medical records. The Privacy Rule applies to most physicians, the civil hospital and other health care providers. In Guam, you have the right to: See and get a copy of your medical record.

Now Accepting these Dental Plans We welcome new patients and accept most insurance plans, including Hawaii Dental Service, Calvo's SelectCare, Staywell, Netcare, Takecare, United Concordia, AETNA, MetLife, Cigna, Medicaid, and MIP. Most health plans with dental benefits cover 100% of preventive care.

Guam is the only territory that covers all mandatory benefits, including nursing facility services. Enrollees can receive care outside of the territory with prior authorization, when medically necessary, and Page 2 2 when services are not provided in Guam (CMS 2014a).

Refer to the licensure verification resource at to determine fees and preferred verification method(s) for each state medical and osteopathic verifying board. You may use this form for each board that requires a written request for verification.

The following are the new Guam Medicaid poverty level income guidelines: Household size: 1 - Monthly gross income: $1,595. Household size: 2 - Monthly gross income: $2,156. Household size: 3 - Monthly gross income: $2,715.

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Guam Request for an Individuals Health Information