Home
Forms Library
Authorization to Use and Disclose Protected - Maricopa County

Authorization to Use and Disclose Protected - Maricopa County 2025

Authorization to Use and Disclose Protected - Maricopa County Preview on Page 1

Show details

4.3 out of 5

27 votes

The document is an authorization form from Maricopa County allowing the Employee Benefits Division to disclose protected health information (PHI) of an individual. It includes details such as the individual's name, identification numbers, the recipient of the PHI, specific types of information to be disclosed, and the purpose for disclosure. The authorization specifies expiration terms and rights regarding revocation and liability release. It also highlights confidentiality protections for certain sensitive information.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The best way to edit Authorization to Use and Disclose Protected - Maricopa County online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your documentation requires just a few simple clicks. Make these quick steps to edit the PDF Authorization to Use and Disclose Protected - Maricopa County online free of charge:

Register and log in to your account. Sign in to the editor with your credentials or click on Create free account to test the tool’s functionality.
Add the Authorization to Use and Disclose Protected - Maricopa County for editing. Click on the New Document button above, then drag and drop the document to the upload area, import it from the cloud, or via a link.
Alter your file. Make any adjustments needed: insert text and photos to your Authorization to Use and Disclose Protected - Maricopa County, underline details that matter, erase sections of content and substitute them with new ones, and insert symbols, checkmarks, and fields for filling out.
Finish redacting the template. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and efficient. Give it a try now!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Should I accept or decline HIPAA authorization?

The Health Insurance Portability and Accountability Act (HIPAA), in most instances, requires a patients written authorization prior to uses and disclosures of their protected health information (PHI).

What is an authorization for the use and disclosure of protected health information?

A covered entity may disclose PHI without the individuals permission for treatment, payment, and health care operations purposes. For other uses and disclosures, the Privacy Rule generally requires the individuals written permission, which is an authorization that must meet specific content requirements.

What requires authorization from the patient for disclosure of PHI?

This is a form used in the nonstandard auto market, for people who do not qualify for automobile insurance from the usual sources because of their bad driving record. Such drivers are required to sign a disclosure authorization form before coverage can be put in force.

Try more PDF tools