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Optum, on behalf of itself and affiliated companies, uses this form to get your permission to use an

Optum, on behalf of itself and affiliated companies, uses this form to get your permission to use an 2025

Optum, on behalf of itself and affiliated companies, uses this form to get your permission to use an Preview on Page 1

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52 votes

The document is an authorization form from Optum that allows patients to permit the use and disclosure of their protected health information (PHI) to designated authorized representatives. It clarifies that this authorization does not grant representatives the power to make treatment decisions on behalf of the patient. The form requires patient and representative information, a description of the PHI to be disclosed, the purpose of disclosure, and includes details about expiration and revocation rights. Patients must sign the form to give consent.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (127 Votes)
2018	4.3 Satisfied (52 Votes)
2016	4.3 Satisfied (46 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a privacy authorization form?

A HIPAA authorization is a form that must be completed by a patient or a health plan member when a covered entity wishes to use or disclose PHI for a purpose not permitted by the HIPAA Privacy Rule. The failure to obtain a valid HIPAA authorization is considered a serious violation of HIPAA compliance.

How to fill out HIPAA privacy authorization form?

How do I fill out a HIPAA release form? Provide instructions. Name the patient and individual authorized to use or disclose their PHI. Describe the information. Specify recipients. Specify the purpose of disclosure. Specify the time period. Detail their revocation rights. Obtain the patients signature.

Should I accept or decline HIPAA authorization?

478-Does the Privacy Rule require that an authorization be notarized or include a witness signature. The Privacy Rule does not require that a document be notarized or witnessed.

Does a HIPAA authorization form need to be notarized?

To respect HIPAA compliance rules, a signed HIPAA release form must be obtained from a patient before their protected health information can be shared with other individuals or organizations, except in the case of routine disclosures for treatment, payment or healthcare operations permitted by the HIPAA Privacy Rule.

Why is a HIPAA authorization form required by a provider prior to treating a patient?

A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations. Continue reading to find out when authorization to disclose health information is needed.