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The document is an authorization form for the release of health information in compliance with HIPAA and New York State Law. It allows patients to request the disclosure of their medical records, including sensitive information related to alcohol and drug treatment, mental health, and HIV-related data. The form outlines the patient's rights regarding the release of this information, including the ability to revoke consent and protections against discrimination. It specifies the entities involved in the release and provides a space for patient signatures.

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What is a HIPAA waiver of authorization?

Waiver of the HIPAA authorization requirement from the IRB. A waiver is a request to forgo the authorization requirement based on the fact that the disclosure of PHI involves minimal risk to the participant and the research cannot practically be done without access to/use of PHI.

What should be included in a authorization for release of 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.

What is a release authorization form?

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.

What is Hipaa authorization?

HIPAA Authorization Defined A HIPAA authorization is consent obtained from an individual that permits a covered entity or business associate to use or disclose that individual's protected health information to someone else for a purpose that would otherwise not be permitted by the HIPAA Privacy Rule.

What is a Form 960?

The Health Insurance Portability and Accountability Act (HIPAA) Form 960 is a document that allows for the release of an individual's personal medical information to a specified entity.

oca official form no 960 fillable

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What is authorization for release of health information?

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.

What are the 3 exceptions to HIPAA?

The Three Exceptions to a HIPAA Breach Unintentional Acquisition, Access, or Use. ... Inadvertent Disclosure to an Authorized Person. ... Inability to Retain PHI.

What is an OCA form?

AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA. [This form has been approved by the New York State Department of Health]

What are the exceptions to the authorization requirement HIPAA?

Exceptions to the HIPAA Privacy Rule This would include purposes such as quality assurance, utilization review, credentialing, and other activities that are part of ensuring appropriate treatment and payment. Limitations apply to uses and disclosures for the purpose of facilitating another party's activities.

What are 5 exceptions to the HIPAA law?

HIPAA Exceptions Defined To public health authorities to prevent or control disease, disability or injury. To foreign government agencies upon direction of a public health authority. To individuals who may be at risk of disease. To family or others caring for an individual, including notifying the public.

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