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New Mexico Authorization for Use and / or Disclosure of Protected Health Information

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US-178EM
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Description

This form allows an employee to authorize the types of medical information to be disclosed by human resources.

New Mexico Authorization for Use and/or Disclosure of Protected Health Information is a legal document that grants permission to healthcare providers to use or share an individual's protected health information (PHI) in accordance with state and federal privacy laws. This authorization ensures that the confidentiality and privacy of patients' health records are maintained while allowing the necessary exchange of information for treatment, payment, and healthcare operations. In New Mexico, there are different types of authorizations for the use and/or disclosure of protected health information. These include: 1. Standard Authorization: This is the most commonly used form of authorization and allows healthcare providers to share a patient's PHI for routine treatment purposes, payment processing, and healthcare operations. 2. Research Authorization: When participating in medical research studies or clinical trials, individuals may be required to sign a research-specific authorization form. This authorization allows the use and/or disclosure of PHI for research purposes only, ensuring that participants' privacy is protected during the study. 3. Mental Health and Substance Abuse Treatment Authorization: Since mental health and substance abuse records have added privacy protections under state and federal laws, individuals seeking treatment in these areas often need to sign a specific authorization form. This authorization allows healthcare providers to share sensitive information related to mental health or substance abuse treatment with other healthcare professionals involved in the patient's care. It is important to note that New Mexico maintains strict confidentiality and privacy standards for accessing and sharing PHI. Healthcare providers must obtain a valid authorization before using or disclosing any protected health information, except in cases where it is required by law or for emergency medical treatment. The New Mexico Authorization for Use and/or Disclosure of Protected Health Information typically includes the following key elements: 1. Patient Information: The authorization includes basic identifying information about the patient, such as their name, contact details, and date of birth. 2. Description of Information: The authorization clearly specifies the types of PHI that can be used or shared. This may include medical records, diagnostic tests, treatment plans, prescription history, or any other relevant healthcare information. 3. Purpose of Use and/or Disclosure: The document outlines the specific reasons for which the PHI will be used or disclosed, such as treatment coordination, insurance claims processing, research purposes, or legal requirements. 4. Duration of Authorization: The authorization indicates the timeframe during which the consent is valid. It may be for a specific period or indicate that the authorization remains valid until revoked by the patient. 5. Signature and Date: The patient must sign and date the authorization to indicate their informed and voluntary consent. In certain cases, the authorization may also require the signature of a legal representative if the patient is a minor or incapable of giving consent. Healthcare organizations in New Mexico are legally obligated to ensure that the authorization forms are clear, well-documented, and comply with state and federal requirements. By obtaining valid authorizations, healthcare providers can safely and lawfully handle protected health information while respecting the privacy and confidentiality of their patients.

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FAQ

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

A patient authorization is not required for disclosure of PHI between Covered Entities if the disclosure is needed for purposes of treatment or payment or for healthcare operations. You may disclose the PHI as long as you receive a request in writing.

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).

Marketing Activities: A covered entity must obtain an individual's authorization prior to using or disclosing PHI for marketing activities. Marketing is considered any message or statement to the public in an effort to get them to use or seek more information about a product or service.

When Must HIPAA Authorization be Obtained? The covered entity can use or disclosure of PHI for marketing purposes. If the marketing communication involves direct or indirect remuneration to the covered entity from a third party, the authorization must state that such remuneration is involved.

Under the HIPAA Privacy Rule, a covered entity must disclose protected health information in only two situations: (a) to individuals (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information; and (b) to the Department of Health

Covered entities may disclose protected health information to: Public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability. Public health or other government authorities authorized to receive reports of child abuse and neglect.

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

One fact sheet addresses Permitted Uses and Disclosures for Health Care Operations, and clarifies that an entity covered by HIPAA (covered entity), such as a physician or hospital, can disclose identifiable health information (referred to in HIPAA as protected health information or PHI) to another covered entity (or

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Complete medical record Complete billing record/itemized bill Dental recordsBox 2267, Santa Fe, NM 87504-2267, and that the revocation will be ...2 pages Complete medical record Complete billing record/itemized bill Dental recordsBox 2267, Santa Fe, NM 87504-2267, and that the revocation will be ... WOMEN'S SPECIALISTS OF NEW MEXICO, LTD. AUTHORIZATION FOR THE USE AND DISCLOSURE OF. INDIVIDUALLY IDENTIFIABLE PROTECTED HEALTH INFORMATION. Patient Name.2 pages WOMEN'S SPECIALISTS OF NEW MEXICO, LTD. AUTHORIZATION FOR THE USE AND DISCLOSURE OF. INDIVIDUALLY IDENTIFIABLE PROTECTED HEALTH INFORMATION. Patient Name.The privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of health ... I hereby authorize the use or disclosure of my individually identifiable health information as described below. Persons/organizations authorized to release ...2 pages I hereby authorize the use or disclosure of my individually identifiable health information as described below. Persons/organizations authorized to release ... (Select one per authorization) or write in the facility name and full address,o If the patient is authorizing the use or disclosure of medical records ...3 pagesMissing: New ?Mexico (Select one per authorization) or write in the facility name and full address,o If the patient is authorizing the use or disclosure of medical records ... In addition, RMCHCS may share your medical information with each other forlaw the records are more protected from use of disclosure than under HIPAA. The New Mexico Children, Youth and Families Department (CYFD) operates under these principles: Confidentiality ? Protected Health Information (PHI) is ... HIPAA requires Covered Entity by law to maintain the privacy of your personalGenerally, we may not use or disclose your personal health information ... USES AND DISCLOSURES OF HEALTH INFORMATION WITHOUT WRITTEN AUTHORIZATIONin allowing a person to pick up filled prescriptions, medical supplies, x-rays, ... TriCore will only use and disclose your PHI after obtaining your written authorization for the following: New Mexico Workers' Compensation Complaints; Marketing ...

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New Mexico Authorization for Use and / or Disclosure of Protected Health Information