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93 DBHDS AUTHORIZATION FOR USE/DISCLOSURE OF ... 2025

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The document is an 'Authorization for Release of Information' form that allows a patient to consent to the use and disclosure of their protected health information (PHI) under HIPAA regulations. It specifies the types of information that can be disclosed, the purpose of the disclosure, and includes provisions for revocation of consent. The form emphasizes the legal protections surrounding the patient's information, particularly in relation to alcohol and drug abuse treatment.

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What 3 types of disclosures do not require patient authorization?

A covered entity is permitted, but not required, to use and disclose protected health information, without an individuals authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3)

What is required for an authorization to disclose PHI?

All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data.

What is included in the authorization for disclosure of PHI?

The name(s) or other specific identification of the person or class of persons to whom information will be disclosed. A description of the purpose of the requested use or disclosure. In cases where a statement of the purpose is not provided, at the request of the individual is sufficient.

Is an individuals written authorization required for disclosures?

A covered entity must obtain the individuals written authorization for any other use or disclosure of PHI, including the marketing and sale of PHI. Individual authorization must be received before using PHI for marketing communications that encourage recipients to purchase or use a product or service.

What are the three components of a valid authorization?

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 must a patients authorization for disclosure of PHI include?

Final answer: A patients authorization for the disclosure of PHI must include the purpose and the information to be released when it relates to treatment for substance abuse.

93 DBHDS AUTHORIZATION FOR USE/DISCLOSURE OF ... 2025

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What 3 types of disclosures do not require patient authorization?

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What is included in the authorization for disclosure of PHI?

Is an individuals written authorization required for disclosures?

What are the three components of a valid authorization?

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What must a patients authorization for disclosure of PHI include?

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93 DBHDS AUTHORIZATION FOR USE/DISCLOSURE OF ... 2025

Here's how it works

How to modify 93 DBHDS AUTHORIZATION FOR USE/DISCLOSURE OF ... in PDF format online

Complete this form in 5 minutes or less

Got questions?

What 3 types of disclosures do not require patient authorization?

What is required for an authorization to disclose PHI?

What is included in the authorization for disclosure of PHI?

Is an individuals written authorization required for disclosures?

What are the three components of a valid authorization?

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