Michigan 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.

Michigan Authorization for Use and/or Disclosure of Protected Health Information is a legal document that grants permission to health entities or individuals to access and disclose a patient's protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Michigan state laws. This authorization ensures that patient privacy rights are protected while allowing healthcare providers to provide necessary treatment, billing, and coordination of care. The Michigan Authorization for Use and/or Disclosure of Protected Health Information is a crucial part of the informed consent process in healthcare. It allows patients to grant specific consent for the use or disclosure of their PHI outside the scope of routine healthcare activities. The authorization specifies the purpose for which the PHI will be used or disclosed and also identifies the individuals or organizations who are authorized to access the information. There are different types of Michigan Authorization for Use and/or Disclosure of Protected Health Information: 1. General Authorization: This type of authorization grants permission for the use and/or disclosure of PHI for a broad range of purposes, such as treatment, payment, healthcare operations, research, or public health activities. It allows healthcare providers to access and disclose PHI as required for routine healthcare activities. 2. Specific Authorization: Sometimes, there may be a need to disclose PHI for specific purposes that are outside the standard healthcare activities covered by general authorization. In such cases, a specific authorization is obtained, which clearly outlines the specific purpose for which the PHI will be accessed or disclosed. For example, if a patient wants to authorize the release of their medical records to an attorney for legal proceedings, a specific authorization is needed. 3. Revocation of Authorization: Patients have the right to revoke their previous authorization at any time, provided that the revocation is done in writing. The revocation ensures that future use and disclosure of PHI are no longer permitted, except as required by law or for actions that took place before the revocation. It is important to note that Michigan Authorization for Use and/or Disclosure of Protected Health Information follows strict guidelines to ensure patient privacy. Any unauthorized use or disclosure of PHI can result in legal consequences and breach of patient confidentiality. Patients should carefully review and understand the authorization before granting permission to access or disclose their PHI, and healthcare providers must comply with these regulations to protect patient rights and privacy.

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FAQ

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?

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.

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

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.

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.

A HIPAA authorization is a detailed document in which specific uses and disclosures of protected health are explained in full. By signing the authorization, an individual is giving consent to have their health information used or disclosed for the reasons stated on the authorization.

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

More info

Use this form to authorize Blue Cross and Blue Shield of Texas (BCBSTX) to disclose your protected health information. (PHI) to a specific person or entity.8 pagesMissing: Michigan ? Must include: Michigan Use this form to authorize Blue Cross and Blue Shield of Texas (BCBSTX) to disclose your protected health information. (PHI) to a specific person or entity. Use this form to allow Blue Cross to share your protected health information (alsoBlue Care of Michigan, Inc. or Blue Cross Complete of Michigan.2 pages Use this form to allow Blue Cross to share your protected health information (alsoBlue Care of Michigan, Inc. or Blue Cross Complete of Michigan.Your Authorization. Except as outlined below, MERS will not use or disclose your PHI unless you have signed a form authorizing the use or disclosure. You have ... The HIPAA Privacy Rule establishes a foundation of Federally-protected rights whichcertain uses and disclosures of their protected health information. You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose. If you give us an authorization, you ... To obtain records, submit a signed and dated Authorization for Use or Disclosure of Protected Health Information to the clinic. The form may be obtained at ... If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at ... Planned Parenthood of Michigan has health centers across Michigan to serve youThis Notice will tell you the ways in which we may use or disclose health ... Instructions for Completing the. Individual Authorization to Release Protected Health Information (PHI) Form. ? Please read the entire form prior to ... If you are the member, please complete sections A ? E of this form.I authorize the use and disclosure of my protected health information (PHI) as ...

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