This form is for use and/or disclosure of the specific personally identifiable health information identified in form, specifically Psychotherapy Notes, pursuant to the requirements of 45 C.F.R. Sect 164.508, which sets out the federal privacy regulations for the Health Insurance Portability and Accountability Act of 1996 and authorizes the Covered Entity identified in the form to release the personally identifiable health information specifically referenced in th form.
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A HIPAA authorization form, also known as a HIPAA release form, is a document that individual signs for their health provider before the entity may use or disclose their protected health information (PHI).
Verb. If someone in authority releases something such as a document or information, they make it available.
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.
Authorization to release information means the form submitted as part of an Application by which Applicants authorize the Office, its officers, employees, agents, independent contractors, and the members of the Review Committee to obtain information about Applicants from third parties, and which authorizes such third ...
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.
Examples of disclosures that would require an individual's authorization include disclosures to a life insurer for coverage purposes, disclosures to an employer of the results of a pre-employment physical or lab test, or disclosures to a pharmaceutical firm for their own marketing purposes.
Psychotherapy notes are primarily for personal use by the treating professional and generally are not disclosed for other purposes. Thus, the Privacy Rule includes an exception to an individual's (or personal representative's) right of access for psychotherapy notes.
§ 164.508?. With few exceptions, the Privacy Rule requires a covered entity to obtain individual authorization prior to a disclosure of psychotherapy notes, even for a disclosure to a health care provider other than the originator of the notes, for treatment purposes.
