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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.
A verbal authorization on file is good for 14 days. The CSR may advise the beneficiary and the caller that if the beneficiary wants the caller to receive information for more than 14 days, the beneficiary should send in a written authorization.
The patient's legal name, date of birth, gender, Social Security number, address, telephone number, guarantor, subscriber, or next-of-kin are key identifying elements that assist in establishing the proper individual.
HIPAA does not impose any specific time limit on authorizations. For example, an authorization could state that it is good for 30 days, 90 days or even for 2 years. An authorization could also provide that it expires when the client reaches a certain age. In this case, the 90-day expiration date is set by the agency.
A HIPAA authorization remains valid until it expires or is revoked by the individual.

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There's no statutory time period within which a release must expire. However, under HIPAA, an authorization to release medical information must include a cutoff date or event that relates to who's authorizing the release and why the information is being disclosed.
What is a Medical Records Release Form? A Medical Records Release Form is used to request that a health care provider (physician, dentist, hospital, chiropractor, psychiatrist, etc.) release a patient's medical records, either to the patient, a third party (such as an employer or insurance company), or both.
There's no statutory time period within which a release must expire. However, under HIPAA, an authorization to release medical information must include a cutoff date or event that relates to who's authorizing the release and why the information is being disclosed.
Alternatively, the person can send an email to: CPHCSCCUWeb@cdcr.ca.gov or send a fax to: (916) 691-2406. If you ask to receive a copy of all of your medical records, you should not be charged for the copies. If you request specific documents, you will be charged $.
AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION CDCR 7385 (Rev. 10/19) Health Care. Personal Use. Legal.

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