This form is for use and/or disclosure of the specific personally identifiable health information identified in form pursuant to the requirements of 45 C.F.R. Sect 164.508, which sets out the federal privacy regulations for the Health Insurance Portability and Accountability Act of 1996 and authorizes the Covered Entity identified in the form to release the personally identifiable health information specifically referenced in th form.
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This form should include specific details such as the person or organization being authorized, the person or organization being sent the information, the nature of the information being shared, the reason for the disclosure of information, and important statements that the patient needs to understand before they sign.
144.293 RELEASE OR DISCLOSURE OF HEALTH RECORDS.
It establishes a presumption that government data are public and are accessible by the public for both inspection and copying unless there is federal law, a state statute, or a temporary classification of data that provides that certain data are not public. Sec. 13.01 MN Statutes mn.gov ? statutes ? cite mn.gov ? statutes ? cite
Conviction of a felony-level criminal sexual conduct offense. (a) The board may not grant a license to practice medicine to any person who has been convicted of a felony-level criminal sexual conduct offense. Sec. 147.091 MN Statutes mn.gov ? statutes ? cite mn.gov ? statutes ? cite
(a) A provider or group purchaser may release patient identifying information and information about the location of the patient's health records to a record locator or patient information service without consent from the patient, unless the patient has elected to be excluded from the service under paragraph (d). Sec. 144.293 MN Statutes MN Revisor's Office (.gov) ? statutes ? cite MN Revisor's Office (.gov) ? statutes ? cite
The Minnesota Data Practices Act is a series of laws designed to guarantee that the public has access to public records of government bodies at all levels. Minnesota FOIA Laws - National Freedom of Information Coalition nfoic.org ? minnesota-foia-laws nfoic.org ? minnesota-foia-laws
Patient information. Whose health records do you want? ... Clinic, hospital, care provider. Who has the information you want? ... Date of Services. Who has the information you want? ... Information to be released. ... Receiving party or destination of records. ... Purpose of release. ... Expiration date or duration of consent. ... Release instructions.
compliant HIPAA release form must, at the very least, contain the following information: 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.
