Contra Costa California Authorization for Release of Personal Information
Description
How to fill out Authorization For Release Of Personal Information?
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FAQ
Authorization to release information is a formal consent that allows an individual or organization to access specific personal data. This document is necessary in many situations, such as medical records, employment, or legal matters. By signing this authorization, you ensure that your information is shared only with those you trust and for designated purposes. This process is vital in managing your privacy effectively in Contra Costa County, California.
Contra Costa Health Plan (CCHP) was the first federally qualified, state licensed, county sponsored HMO in the United States. CCHP has been serving the health needs of people in Contra Costa County for over 45 years, and now serves over 227,000 people.
This form is used to release your protected health information as required by federal and state privacy laws. Your authorization allows the Health Plan (your health insurance carrier or HMO) to release your protected health information to a person or organization that you choose.
Applications are available from Health Care Options: call 1-800-430-4263. Complete information and application assistance is available through Contra Costa Health Plan's Marketing office: 1-800-211-8040 Monday?Friday 8 a.m.?5 p.m.
That is why a medical record authorization for the release of information is necessary: it protects a healthcare provider from litigation, gives express approval for the receiving party to do with the information what they will, and it provides a public record that the patient, the healthcare provider, and the third
Medi-Cal, California's Medicaid program, is a public insurance health care program which provides health care services for low-income individuals and families who meet defined eligibility requirements.
The authorization form (sometimes called a patient HIPAA consent form), essentially serves as a handy dandy permission slip allowing a practice or business associate to use or disclose protected health information (PHI) in the ways a patient wants their data used.
What Is Release of Information? Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.
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.
Contra Costa Health Plan (CCHP) has a Medi/Cal contract with the California Department of Health Care Services (DHSC).
