This form is for use and/or disclosure of the specific personally identifiable health information identified in form 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 covered entity is permitted, but not required, to use and disclose protected health information, without an individual's authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) ...
Hear this out loud PauseIn general, the CMIA prohibits health care providers, health care service plans, contractors, and pharmaceutical companies from disclosing patient medical information without first receiving a valid written authorization signed by the patient or the patient's legal representative.
Elements: A description of the PHI. The name of the person making the authorization. The name of the person or organization who is authorized to receive the PHI. A description of the purpose for the use or disclosure. An expiration date for the authorization. The signature of the person making the authorization.
Hear this out loud PauseWho ultimately decides whether a medical record can be released? The patient ultimately decides whether his or her medical record can be released.
The physician must always have the patient's permission to release information for nontherapeutic purposes--for example, collecting insurance, determining job fitness, documenting sick leave, and other situations in which the release of information is not related to the patient's medical treatment.
Hear this out loud PauseAn authorization to release the information, signed by the patient, is required before records may be released, but most health care providers incorporate the release into the patient registration form so that information can be provided in a timely manner.
(10) Medical record information shall be confidential. There shall be written procedures for the use and removal of medical records and the release of patient information. (a) Information may be disclosed only to authorized persons in ance with federal and state laws, and clinic policy.
Hear this out loud PauseAccess. Only you or your personal representative has the right to access your records. A health care provider or health plan may send copies of your records to another provider or health plan only as needed for treatment or payment or with your permission.
