This is a form signed by an individual who wants to grant permission for a health care provider or hospital to release their medical records and/or billing information to another individual other than the patient as is required by the Health Insurance Portability and Accountability Act (HIPPA).
Wake North Carolina Permission To Disclose Health Billing Information
Category:
State:
Multi-State
County:
Wake
Control #:
US-PRM-26
Format:
Word;
Rich Text
Instant download
Description
How to fill out Permission To Disclose Health Billing Information?
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FAQ
The medical record information release (HIPAA) form lets a patient allow any person or 3rd party to have access to their health records. The form also allows the added option for healthcare providers to share information with each other.
Unauthorized access to patient medical records occurs when an individual who lacks authorization, permission, or other legal authority, accesses data, including protected health information (PHI), contained in patient medical records.
A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.
With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.
The content of the designated record set includes medical and billing records of covered providers; enrollment, payment, claims, and case information of a health plan; and information used in whole or in part by or for the covered entity to make decisions about individuals.
With limited exceptions, the HIPAA Privacy Rule gives individuals the right to access, upon request, the medical and health information (protected health information or PHI) about them in one or more designated record sets maintained by or for the individuals' health care providers and health plans (HIPAA covered
A HIPAA authorization form is a document in that allows an appointed person or party to share specific health information with another person or group. Your appointed person can be a doctor, a hospital, or a health care provider, as well as certain other entities such as an attorney.
Under HIPAA, patients have a right to request amendments to their medical records, but it is up to the provider to decide whether or not to do it. However, regardless of what the provider decides, they must respond to the patient's amendment request.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
Questions? To speak with the Medical Records department, call 919-350-8370.
