Nebraska Request for Restrictions on Uses and Disclosures of Protected Health Information

State:
Multi-State
Control #:
US-3582
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to request restrictions on the disclosure and use of the individual's protected health information. The individual's rights regarding restricting such use and disclosure are explained, as well as the responsibilities of the record provider in regard to the restrictions.
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How to fill out Request For Restrictions On Uses And Disclosures Of Protected Health Information?

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FAQ

The Privacy Rule permits use and disclosure of protected health information, without an individual's authorization or permission, for 12 national priority purposes.

We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

Which use/disclosure of PHI is allowed under the HIPAA Privacy Rule? Discussing a patient's case with a provider involved in the patient's care. PHI should be disclosed only to those with a need to know, such as providers involved in the patient's care.

There are a few scenarios where you can disclose PHI without patient consent: coroner's investigations, court litigation, reporting communicable diseases to a public health department, and reporting gunshot and knife wounds.

In general, a covered entity may only use or disclose PHI if either: (1) the HIPAA Privacy Rule specifically permits or requires it; or (2) the individual who is the subject of the information gives authorization in writing.

We may disclose your PHI for the following government functions: (1) Military and veterans activities, including information relating to armed forces personnel for the execution of military missions, separation or discharge from military services, veterans benefits, and foreign military personnel; (2) National security

Health information such as diagnoses, treatment information, medical test results, and prescription information are considered protected health information under HIPAA, as are national identification numbers and demographic information such as birth dates, gender, ethnicity, and contact and emergency contact

However, PHI can be used and disclosed without a signed or verbal authorization from the patient when it is a necessary part of treatment, payment, or healthcare operations. The Minimum Necessary Standard Rule states that only the information needed to get the job done should be provided.

To disclose patient information, healthcare executives must determine that patients or their legal representatives have authorized the release of information or that the use, access or disclosure sought falls within the permitted purposes that do not require the patient's prior authorization.

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Nebraska Request for Restrictions on Uses and Disclosures of Protected Health Information