Authorization for disclosure of protected health information template: Fill out & sign online

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.

How to quickly redact Authorization for Use/Disclosure of Protected Health Information online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the best editor for modifying your forms online. Follow this straightforward guide to redact Authorization for Use/Disclosure of Protected Health Information in PDF format online free of charge:

Sign up and log in. Register for a free account, set a secure password, and proceed with email verification to start managing your forms.
Upload a document. Click on New Document and choose the form importing option: add Authorization for Use/Disclosure of Protected Health Information from your device, the cloud, or a protected link.
Make adjustments to the template. Utilize the upper and left-side panel tools to redact Authorization for Use/Disclosure of Protected Health Information. Add and customize text, pictures, and fillable fields, whiteout unnecessary details, highlight the important ones, and provide comments on your updates.
Get your paperwork done. Send the form to other parties via email, create a link for quicker file sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail added.

Discover all the benefits of our editor today!

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.

Contact us

What are two required elements of an authorization needed to disclose PHI?

All authorizations must be in plain language, and contain specific information regarding the information to be disclosed or used, the person(s) disclosing and receiving the information, expiration, right to revoke in writing, and other data.

What information must be on the authorization form?

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.

When can you use or disclose PHI?

In general, a covered entity may only use or disclose PHI if either: (1) the HIPAA Privacy Rule specifically permits or requires it; or (2) the individual who is the subject of the information gives authorization in writing.

What does disclosure authorization mean?

Authorized Disclosure means the disclosure of Protected Information strictly in accordance with the Confidentiality Control Procedures applicable thereto: (i) as to all Protected Information, only to a Related Party that has a need to know such Protected Information strictly for Project Purposes and that has agreed in ...

When authorization is needed for use and disclosure of PHI?

Answer: A patient authorization is not required for disclosure of PHI between Covered Entities if the disclosure is needed for purposes of treatment or payment or for healthcare operations. You may disclose the PHI as long as you receive a request in writing.

Related forms

be ready to get more