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See more health patient authorization form versions

We've got more versions of the health patient authorization form form. Select the right health patient authorization form version from the list and start editing it straight away!
Versions Form popularity Fillable & printable
2012 5 Satisfied (55 Votes)
2011 4.3 Satisfied (194 Votes)
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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.
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.
The medical record information release (HIPAA) form allows a patient to give authorization to a 3rd party and access their health records. The release also allows the added option for healthcare providers to share information.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.
When your healthcare provider recommends specific medical care, you can agree to all of it, or only some of it. Before the procedure, you'll have to complete and sign a consent form. This form is a legal document that shows your participation in the decision and your agreement to have the procedure done.
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Generally, an authorization provides the authority for a doctor's 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.
The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.
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.
Release of information (ROI) is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive or review it.
An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

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