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Oregon Authorization for Use and Disclosure of Information

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

Definition and meaning

The Oregon Authorization for Use and Disclosure of Information is a legal form that allows individuals to authorize specific organizations or individuals to access their personal information and records. This authorization is essential for sharing confidential information in various contexts, including medical, educational, and legal settings.

How to complete the form

To complete the Oregon Authorization for Use and Disclosure of Information form, follow these steps:

  1. Provide personal details: Fill in your full legal name, date of birth, and any other names you may have used.
  2. Identify the record holder: Specify which individual, agency, or entity holds your records and what specific information you are authorizing them to release.
  3. Indicate mutual exchange: Decide if a mutual exchange of information is necessary.
  4. Detail the recipients: List the individuals or organizations that will receive your information, including their addresses.
  5. State the purpose: Clearly indicate the purpose of this authorization.
  6. Set an expiration date: Specify an expiration date or event for this authorization.
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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