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UCMC-218 AUTHORIZATION FOR RELEASE OF PATIENT PROTECTED HEALTH INFORMATION.indd

UCMC-218 AUTHORIZATION FOR RELEASE OF PATIENT PROTECTED HEALTH INFORMATION.indd 2025

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The document is an authorization form for the release of patient protected health information (PHI) from a hospital or facility. It collects patient details, specifies the types of PHI to be disclosed, and outlines the reasons for the request. The form includes important privacy notices regarding the potential re-disclosure of information and states that the authorization will expire in 60 days unless otherwise specified. It also addresses conditions related to drug and alcohol abuse, psychiatric issues, and HIV testing.

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What requires an authorization to release protected health information?

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).

Who can authorize the release of a patients information?

A personal representative generally has the right to access or authorize disclosures of information just like the patient. (45 CFR 164.502(g)(1)).

Who determines what information is released from a medical record?

If the patient is not available or incapacitated, or if an emergency circumstance exists, the provider may, in the exercise of professional judgment, determine whether the disclosure is in the best interests of the patient, and if so disclose that information relevant to that persons involvement in the patients

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What should be included in a release of information form?

A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed. An expiration date or expiration event when consent to use/disclose the information is withdrawn.

How do I fill out an authorization to release information?

Content for a valid authorization includes: The name of the person or entity authorized to make the request (usually the patient) The complete name of the person or entity to receive the protected health information (PHI) A specific description of the information to be used or disclosed, including the dates of service.

What information must be on the authorization form for the release of patient information?

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.

Who ultimately decides whether a medical record can be released quizlet?

The patient ultimately decides whether his or her medical record can be released. Which statement is not accurate about correcting charting errors? -Insert the correction above or immediately after the error. -Draw two clear lines through the error.

Which circumstance requires an authorization to release protected health information?

Authorization. A covered entity must obtain the individuals 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.

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Who ultimately decides whether a medical record can be released quizlet?

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