New Jersey Authorization to Release Confidential Records

State:
Multi-State
Control #:
US-PI-0312
Format:
Word; 
Rich Text
Instant download

Description

This form authorizes the release of plaintiff's confidential medical records to plaintiff's attorney.

How to fill out Authorization To Release Confidential Records?

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FAQ

Both the HIPAA Privacy Rule and New Jersey law give you rights to your medical record. The HIPAA Privacy Rule sets standards that apply to records held by health care providers across the nation. New Jersey law sets standards for records held by health care providers within the state.

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.

These core elements include: The specific information that will be used or disclosed. The specific identifiers of the individuals(s) authorized to make the requested use or disclosure. The specific identification of any third parties who the covered entity may make the requested disclosure.

A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

I hereby authorize use or disclosure of protected health information about me as described below. I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.

A health care provider may disclose a patient's PHI for treatment purposes without having to obtain the authorization of the individual. Treatment includes the coordination or management of health care by a health care provider with a third party.

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New Jersey Authorization to Release Confidential Records