New Hampshire Authorization for Medical Information

State:
Multi-State
Control #:
US-PI-0244
Format:
Word; 
Rich Text
Instant download

Description

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.

The New Hampshire Authorization for Medical Information is a legal document that allows individuals to authorize the disclosure of their medical information for various purposes. This authorization form is designed to comply with the state-specific laws and regulations of New Hampshire regarding the confidentiality and release of medical records. The primary purpose of the New Hampshire Authorization for Medical Information is to grant consent to healthcare providers, insurance companies, employers, or other relevant parties to access an individual's confidential medical records. This authorization is typically required in situations where individuals want to share their medical information with third parties for various reasons, such as applying for insurance, seeking employment, or participating in research studies. New Hampshire offers several types of authorizations for medical information, depending on the specific purpose for which the information will be disclosed. Some common types include: 1. General Medical Information Authorization: This type of authorization allows for the release of an individual's general medical information to designated parties. It covers a broad range of medical records, including diagnoses, treatments, medications, and laboratory results. 2. Mental Health Information Authorization: In cases where an individual's mental health records need to be disclosed, a separate authorization form is required. This specific authorization ensures the privacy of sensitive mental health information, including psychiatric evaluations, therapy session notes, and any psychological assessments. 3. Substance Abuse Treatment Information Authorization: Individuals seeking to disclose their substance abuse treatment records must use this specific authorization form. This ensures the confidentiality of information related to drug or alcohol treatment, including outpatient therapy, inpatient rehabilitation, and counseling sessions. 4. Minor Medical Information Authorization: When individuals with legal guardianship wish to authorize the disclosure of a minor's medical records, they can use this specific form. It grants permission to access and release the minor's medical information to healthcare providers, educational institutions, or any other relevant parties involved in the child's care. 5. Research Study Information Authorization: In the context of research studies, participants may need to authorize the sharing of their medical information. This unique form allows for the release of medical records solely for research purposes, ensuring that researchers abide by ethical guidelines and maintain participant privacy. It is essential for individuals to complete the appropriate New Hampshire Authorization for Medical Information form accurately and thoroughly. Each form includes specific details and instructions, such as the duration of authorization, parties authorized to receive the information, and the purpose for which the information will be disclosed. It's crucial to consult with legal professionals or healthcare providers to ensure compliance with New Hampshire's laws and regulations regarding medical information disclosure.

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STATE LAW, RSA 332-I, allows patients to obtain a copy of their medical records for a limited charge. RSA 332-I states the following: ?332-I:1 Medical Records. ? All medical information contained in the medical records in the possession of any health care provider shall be deemed to be the property of the patient.

The New Hampshire Right to Know Law is a series of statutes designed to guarantee that the public has access to public records of governmental bodies. Public records are any information created, accepted, or obtained by, or on behalf of, any public body.

The Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are two examples of federal laws that regulate privacy and the exchange of specific types of information.

Mandatory disclosure of information Under the CMIA, medical information must be released when compelled: by court order. by a board, commission or administrative agency for purposes of adjudication. by a party to a legal action before a court, arbitration, or administrative agency, by subpoena or discovery request.

The proper release of medical records always requires authorization to protect the patient's privacy and to help keep you from being liable.

Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join Our Network. Urine Drug Screens rendered by MAT (Medication Assisted Treatment) providers require notification only. Prior auth is not required.

The patient shall be fully informed by a health care provider of his or her medical condition, health care needs, and diagnostic test results, including the manner by which such results will be provided and the expected time interval between testing and receiving results, unless medically inadvisable and so documented ...

Generally, health care providers may charge you for copying your medical record. In New Hampshire, your provider is allowed to charge you no more than $15 for the first 30 pages or $. 50 per page, whichever is greater. Your provider can also charge you the actual cost of postage if you have the copies sent to you.

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NOTE: If you are seeking records from New Hampshire Hospital (NHH), please contact the Medical Records Unit at 603-271-. 5300 or MedicalRecordRequests@dhhs.nh. Complete the Disclosure of Patient Information Form.pdf .pdf Icon . You ... the Authorization to Disclose Protected Health Information to New Hampshire Hospital?Mar 19, 2018 — Health Plan: Enter name of authorizing entity (i.e. New Hampshire Healthy Families, Well Sense, NH. Medicaid Fee for Service). 1a. Please choose ... Step 4. Please read carefully and authorize the information to be released. If my initials appear here: _____, I authorize the release of ALL RECORDS which ... Complete our authorization to disclose protected health information form. Download Form Now. It's a good idea to keep copies of your medical records. You'll ... You can also file a grievance by phone at 1-833-704-1177 (TTY 1-855-534-6730). If you need help filing a grievance, AmeriHealth Caritas New Hampshire Member ... To authorize others to view and manage your medical records. Please fill out one of the following forms and mail or return it to us: Designation of Personal ... To request the form be faxed or mailed to you, please call (603) 663-2341. For assistance in completing the form, click here. You may also pick up a copy of the ... You still need to complete an Authorization to Release Medical Records form. When requesting your medical records electronically, you can request this be ... I understand that this authorization may be revoked in writing and delivered to the Medical Records Department of Foundation Medical Partners. (399 Daniel ...

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New Hampshire Authorization for Medical Information