This form is used to inform the plaintiff's medical provider that an attorney has been retained by plaintiff and that plaintiff authorizes the release to attorney of all of his or her medical records.
Indiana Authorization for Medical Information
State:
Multi-State
Control #:
US-PI-0244
Format:
Word;
Rich Text
Instant download
Description
Free preview
How to fill out Authorization For Medical Information?
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FAQ
A release of information document is a document signed by the authorizing person, allowing the recipient or holder of information to disclose or use the information through the consent of the owner.
The proper release of medical records always requires authorization to protect the patient's privacy and to help keep you from being liable.
Under Indiana medical records laws, only the patient, authorized representative, or an authorized health case worker has access to medical records, except by subpoena or other court order.
The name(s) or other specific identification of person(s) or class of persons authorized to make the requested use or disclosure. The name(s) or other specific identification of the person(s) or class of persons who may use the PHI or to whom the covered entity may make the requested disclosure.
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 covered entity is permitted, but not required, to use and disclose protected health information, without an individual's authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) ...
A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.
HIPAA Authorization Defined A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.