Maine Release and Authorization is a legal document between two parties, allowing the release and exchange of information. This document is common in Maine, where it is required by state law and is used to protect the privacy of individuals. There are two types of Maine Release and Authorization forms: the first is for releasing medical information to another party or institution, and the second is for releasing financial information. Both forms require the consent of both parties and provide the ability to limit the scope of information released. The Maine Release and Authorization form must be signed by both parties and notarized in order to be valid.
Maine Release and Authorization
State:
Maine
Control #:
ME-HIPAA-2
Format:
Word;
Rich Text
Instant download
Description
HIPAA authorization form specifically for Maine
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FAQ
Description. The Third Party Authorization form authorizes a person other than the payor or recipient to act on the payor's or recipient's behalf. A Family Responsibility Office (FRO) support payor or support recipient may designate this person to request and receive information from the FRO regarding their case.
A HIPAA authorization form, also known as a HIPAA release form, is a document that individual signs for their health provider before the entity may use or disclose their protected health information (PHI).
By setting up a Release Authorization (ARI), you are giving customer service your permission to disclose information about your accounts to another person. Typically, this is used to give account access to a spouse or other family member.
I understand that this information is protected by law and cannot be released/requested without my written consent unless otherwise provided by law. I further understand that this consent may be revoked by me, in writing at any time, except if the information has already been released or obtained.
More info
No information is available for this page. Note: All applicable fields must be completed for this form to be considered valid.Request Medical Records. B. Date of Rehire (if applicable). Please read this form carefully. ❒Office of Maine Care Services. PhotoVideo Release Form 2011.doc. After this form has been completed and signed, the Navigator will send the original to the Homeless Initiatives Program Officer. 3. Pursuant to 25 MRSA §2003 (1)(E)(1), I authorize the Riverview Psychiatric Center and the Dorothea Dix Psychiatric. Authorization for Release of Information.