This is an official form from the United States District Court District of New Mexico, which complies with all applicable laws and statutes. USLF amends and updates the forms as is required by New Mexico statutes and law.
New Mexico HIPPA - Authorization to Disclose Protected Health Information
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FAQ
The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.
No, a HIPAA Authorization does not need to be notarized. In fact, you don't even need a witness to see you sign the form.
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
Description of PHI to be used or disclosed (identifying the information in a specific and meaningful manner). The name(s) or other specific identification of person(s) or class of persons authorized to make the requested use or disclosure.Description of each purpose of the requested use or disclosure.
What is HIPAA Waiver of Authorization. A legal document that allows an individual's health information to be used or disclosed to a third party. The waiver is part of a series of patient-privacy measures set forth in the Health Insurance Portability and Accountability Act (HIPAA) of 1996.