This form authorizes the release of plaintiff's confidential medical records to plaintiff's attorney.
Virginia Authorization to Release Confidential Records
State:
Multi-State
Control #:
US-PI-0312
Format:
Word;
Rich Text
Instant download
Description
How to fill out Authorization To Release Confidential Records?
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FAQ
A request for copies of medical records must be in writing, dated and signed by the person making the request, and include a reasonable description of the records sought. If someone is making a request on your behalf, he or she must provide evidence of the authority to receive the records (such as a power of attorney).
When the health records requested pursuant to subsection B1 are produced in paper or hard copy format from records maintained in (i) paper or other hard copy format or (ii) electronic storage, a health care provider may charge the requester a reasonable fee not to exceed $0.50 per page for up to 50 pages and $0.25 per ...
The Veterans Benefits Administration (VBA) uses VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), to request private medical records and information regarding the source of records in support of claims for compensation and/or pension benefits.
An entity that maintains computerized data that includes medical information that the entity does not own or license shall notify the owner or licensee of the information of any breach of the security of the system without unreasonable delay following discovery of the breach of the security of the system, if the ...
Code of VA § 8.01-413 (B) permits health care entities to charge fees to attorneys, insurers and others authorized by the patient for copies of medical records.
Virginia Code § 32.1-127. requires that when the health records of a pro se party or non-party witness are subpoenaed from the health care entity, a notice must be provided to the individual.
No person to whom health records are disclosed shall redisclose or otherwise reveal the health records of an individual, beyond the purpose for which such disclosure was made, without first obtaining the individual's specific authorization to such redisclosure.
