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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.
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.
More generally, HIPAA allows the release of information without the patients authorization when, in the medical care providers best judgment, it is in the patients interest. Despite this language, medical care providers are very reluctant to release information unless it is clearly allowed by HIPAA.
The HIPAA Privacy Rule requires that an individual provide signed authorization to a covered entity, before the entity may use or disclose certain protected health information (PHI).
A covered entity is permitted, but not required, to use and disclose protected health information, without an individuals authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3)
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More generally, HIPAA allows the release of information without the patients authorization when, in the medical care providers best judgment, it is in the patients interest.
Content for a valid authorization includes: The name of the person or entity authorized to make the request (usually the patient) The complete name of the person or entity to receive the protected health information (PHI) A specific description of the information to be used or disclosed, including the dates of service.
If the marketing involves financial remuneration, to the covered entity from a third party, the authorization must state that such remuneration is involved. A covered entity must obtain an authorization for any disclosure of protected health information which is a sale of protected health information.

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