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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An 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.
Authorization. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.
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.
The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization.
Under the HIPAA Privacy Rule, when a release of information is intended for purposes other than medical treatment, healthcare operations, or payment, you'll need to sign an authorization for ROI. The healthcare organization releasing your information will check that the authorization is valid during the ROI process.
Under the HIPAA Privacy Rule, healthcare providers, health plans, business associates, and others involved in administration of healthcare, may not share a patient's protected health information (PHI) without that patient's written authorization.
More generally, HIPAA allows the release of information without the patient's authorization when, in the medical care providers' best judgment, it is in the patient's interest.
PHI may also be disclosed to prevent and lessen a serious and imminent threat of harm to a specific person or the public at large, provided no state law is to the contrary. Such disclosure does not require written patient authorization.
