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Generally, an authorization provides the authority for a doctors release of PHI for specified purposes, which are generally other than treatment, payment, or healthcare operations, or, to disclose protected health information to a third party specified by the individual.
Essential information to include: Date of birth. Name. Social Security number. Contact information (address and phone number) Email address. Dates of service and specific records requested (tests, discharge notes, etc.) Method of delivery (email, in person, through mail)
Before a patients information is released to anyone, such as a family member or another physician, the patient must give written authorization.
Authorization. A covered entity must obtain the individuals written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.
Elements: A description of the PHI. The name of the person making the authorization. The name of the person or organization who is authorized to receive the PHI. A description of the purpose for the use or disclosure. An expiration date for the authorization. The signature of the person making the authorization.
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By contrast, an authorization of release of PHI (as opposed to consent) is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. The patient must provide the authorization of release of PHI to the covered entity.
A HIPAA-compliant HIPAA release form must, at the very least, contain the following information: A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.
The written authorization form is commonly called a HIPAA medical release form (or medical records release authorization form). The authorization must be obtained before any PHI can be disclosed.

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