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Oregon Authorization for Use and Disclosure of Information

State:
Oregon
Control #:
OR-00426
Format:
Word; 
Rich Text
Instant download

Description

This form is an authorization to release information held by an individual, a school, employer, agency or medical provider. The authorization granted with this release can be cancelled at any time. The information be re-disclosed to the Department of Human Services or the Oregon Helath Authority.

Oregon Authorization for Use and Disclosure of Information is a form used in the state of Oregon that allows individuals to authorize the release of their personal health information to specified third parties. This includes health care providers, health plans, and other organizations that are involved in the treatment, payment, and operations of their health care. The form is designed to protect individuals’ privacy and provide the necessary information to ensure the accuracy and protection of their health information. There are two types of Oregon Authorization for Use and Disclosure of Information forms, including a general form and a specific form. The general form is used to provide authorization for the release of information related to the individual’s diagnosis, treatment, and health care services. The specific form is used to authorize the release of specific health information, such as laboratory test results, medical records, mental health information, and other more specific types of information. Both forms require the individual’s signature and the signature of the health care provider or other authorized person.

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FAQ

This authorization is valid for one year from the date of signing unless otherwise specified. may be subject to re-disclosure and no longer protected under federal or state law.

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.

Authorization. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.

Authorized Disclosure means the disclosure of Protected Information strictly in ance with the Confidentiality Control Procedures applicable thereto: (i) as to all Protected Information, only to a Related Party that has a need to know such Protected Information strictly for Project Purposes and that has agreed in

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.

When Must Patient Authorization be Obtained for Uses and Disclosures of PHI? Authorizations are generally required for psychotherapy notes, substance abuse disorder and treatment records, and for marketing purposes.

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Oregon Authorization for Use and Disclosure of Information