General Medical Release form - Samaritan Medical Center 2025

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The patient may enter the date he/she wants the authorization to expire. The patient may enter an expiration event. The patient may enter a date range of information to be shared. If no expiration date is specified, this authorization is good for 12 months from the date signed in Section IX.
How do I fill out a HIPAA release form? Provide instructions. Name the patient and individual authorized to use or disclose their PHI. Describe the information. Specify recipients. Specify the purpose of disclosure. Specify the time period. Detail their revocation rights. Obtain the patients signature.
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.
​ A stand alone Medical Records Release and Authorization to Use and Disclose Health Information Form will state that this authorization does not have an expiration date (unless superceded by state or local laws).
QUICK SUMMARY: Under Californias Confidentiality of Medical Information Act, a patients consent for the use or disclosure of their health information is valid only for one year from the date they sign.

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How long is a HIPAA authorization valid? A HIPAA authorization is valid until a patient or their personal representative revokes it unless an expiry date is included in the initial authorization form.

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