Virginia Authorization to Use or Disclose Protected Health Information

State:
Multi-State
Control #:
US-3580
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to consent to the use or disclosure of protected health information as described within. The individual also indicates the acknowledgment of his or her rights regarding consent to the use and disclosure of the information.
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FAQ

HIPAA Authorization DefinedAn authorization must be in writing, written in plain language, and must contain specific elements and statements to be valid. The specific elements and statements in a valid authorization are: Elements: A description of the PHI.

However, PHI can be used and disclosed without a signed or verbal authorization from the patient when it is a necessary part of treatment, payment, or healthcare operations. The Minimum Necessary Standard Rule states that only the information needed to get the job done should be provided.

In general, a covered entity may only use or disclose PHI if either: (1) the HIPAA Privacy Rule specifically permits or requires it; or (2) the individual who is the subject of the information gives authorization in writing.

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.

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

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).

A HIPAA authorization is a detailed document in which specific uses and disclosures of protected health are explained in full. By signing the authorization, an individual is giving consent to have their health information used or disclosed for the reasons stated on the authorization.

In limited circumstances, the HIPAA Privacy Rule permits covered entities to use and disclose health information without individual authorization. Covered entities may use and disclose protected health information without authorization for their own treatment, payment, and healthcare operations.

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.

The HIPAA Privacy Rule requires that an individual provide signed authorization to a covered entity, before the entity may use or disclose certain protected health information (PHI).

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Virginia Authorization to Use or Disclose Protected Health Information