Patient authorization for release of medical information - Mount Sinai - mountsinai 2025

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By signing the authorization, an individual is giving consent to have their health information used or disclosed for the reasons stated on the 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.
The person who authorizes the release of medical information is primarily the patient, as established by HIPAA. Patients have the right to control access to their medical information and can specify who can view it.
A HIPAA release form is a document that when signed allows healthcare providers to share a patients protected health information (PHI) with specified individuals or organizations, ing to the details stipulated in the form.
IN PERSON/VIA MAIL or EMAIL Medical Record Request If you are unable to complete your records request online, records may also be requested by visiting the Health Information Department to fill out an authorization form, mailing/faxing an authorization form, or emailing an authorization form to the HIM Office.
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A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations.
Authorization for release of information means the form prescribed by the agency for the purpose of authorizing the release of a confidential record, signed and dated by the person empowered to release the information.

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