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The document is an authorization form for the use and disclosure of a patient's health information by Edward Elmhurst Health. It outlines the patient's personal information, the specific health records to be disclosed, the entities involved in the release and receipt of this information, and the purposes for which it is being shared. The form emphasizes that signing is voluntary, details patient rights regarding their health information, and includes sections for signatures from the patient or their authorized representative.

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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 an authorization for use or disclosure of patient health information?

A Privacy Rule Authorization is an individuals signed permission to allow a covered entity to use or disclose the individuals protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

What is authorization for use of health information?

Elmhurst HCs various departments and facilities use Epic EMR to record and process the flow of information regarding patients seeking and receiving medical care at the hospital and its affiliated clinics, from intake to discharge and subsequent follow-up care.

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.

What is an example of when authorization is needed for use and disclosure of PHI?

When Must Patient Authorization be Obtained for Uses and Disclosures of PHI? Authorizations are generally required for psychotherapy notes, substance abuse disorder and treatment records, and for marketing purposes.

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.

elmhurst hospital medical records phone number

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Does Elmhurst Hospital use epic?

I, the undersigned, authorize the release of, or request access to the information specified below from the medical record(s) of the above name patient. I understand that my records are confidential and cannot be disclosed without my written authorization, except when otherwise permitted by law.

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What is an authorization for use or disclosure of patient health information?

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What must a patients authorization for disclosure of PHI include?

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Does Elmhurst Hospital use epic?

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