Utah Authorization for Use and / or Disclosure of Protected Health Information

State:
Multi-State
Control #:
US-178EM
Format:
Word; 
Rich Text
Instant download

Description

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

Utah Authorization for Use and/or Disclosure of Protected Health Information is a legal document that allows individuals to authorize the use or disclosure of their protected health information (PHI) in compliance with the state's healthcare privacy laws. This authorization is necessary for healthcare providers, insurers, and other entities to share an individual's PHI for purposes beyond treatment, payment, and healthcare operations. Utah recognizes various types of authorizations based on specific circumstances and purposes. Here are some key types of Utah Authorization for Use and/or Disclosure of Protected Health Information: 1. General Authorization: This type of authorization covers a broad range of uses and disclosures of PHI. It grants permission for healthcare providers to share an individual's health information with outside parties, such as other healthcare providers, family members, or research institutions. 2. Authorization for Psychotherapy Notes: In compliance with federal regulations, this specific authorization is required to release a patient's psychotherapy notes. These notes are separate from regular medical records and contain the therapist's personal observations and interpretations. 3. Authorization for HIV/AIDS-Related Information: Utah has specific laws protecting the confidentiality of HIV/AIDS-related information. Therefore, a separate authorization is necessary for healthcare providers to disclose or use an individual's HIV/AIDS-related information. This authorization ensures privacy and non-discrimination regarding such sensitive health information. 4. Authorization for Substance Abuse Treatment Records: Individuals seeking substance abuse treatment may require a separate authorization for the disclosure or use of their substance abuse treatment records. This authorization aims to protect the privacy of patients seeking assistance for substance abuse issues. It is important to note that each type of Utah Authorization for Use and/or Disclosure of Protected Health Information outlines the purpose, scope, and specific entities involved in the permitted use or disclosure of PHI. This helps ensure that patients have control over their health information and are informed about who can access their records and for what purposes. Utah's Authorization for Use and/or Disclosure of Protected Health Information is an essential instrument in safeguarding patient privacy and maintaining compliance with state and federal regulations. By obtaining proper authorization, healthcare providers can ensure the transparent sharing of PHI while respecting individuals' rights and maintaining the confidentiality of their health information.

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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

Valid HIPAA Authorizations: A ChecklistNo Compound Authorizations. The authorization may not be combined with any other document such as a consent for treatment.Core Elements.Required Statements.Marketing or Sale of PHI.Completed in Full.Written in Plain Language.Give the Patient a Copy.Retain the Authorization.

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.

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.

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).

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

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

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.

More info

By completing this document, you authorize the disclosure and/or use of yourauthorize Health Choice Generations Utah to disclose my health information. Not every use or disclosure in a category will be listed. However, unless we ask for a separate authorization, all of the ways we are permitted to use and ...This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health ... A HIPAA covered entity also may disclose PHI to law enforcement without the individual's signed HIPAA authorization in certain incidents, including: ? To report ...2 pages A HIPAA covered entity also may disclose PHI to law enforcement without the individual's signed HIPAA authorization in certain incidents, including: ? To report ... You may revoke your authorization to use or disclose any personal health information at any time, except to the extent that we have taken action in reliance on ... How We May Use and Disclose Protected Health Information About You. The following categoriesto determine whether the Plan will cover the treatment.7 pages How We May Use and Disclose Protected Health Information About You. The following categoriesto determine whether the Plan will cover the treatment. The following uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, ... PROTECTED HEALTH INFORMATION. Please read this entire form before signing and complete allform or any other form that complies with HIPAA, the Texas. UT Health Science Center San Antonio Institutional Review Boards. HIPAA Waiver/Alteration for Research Use of PHI. Using this form ? To check the checkboxes ... As a patient of Central Utah Clinic, P.C. dba Revere Health, you are entitled to receiveHow We Use And Disclose Your Protected Health Information.

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Utah Authorization for Use and / or Disclosure of Protected Health Information