Get Consent to Release of Medical History

[Please Print] 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.

A release of information is a statement signed by the client authorizing a contact person to give the division information about the client's situation.

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. ... Relates to the past, present, or future physical or mental health or condition of an individual and the payment for the provision of health care.

*A job as a Release of Information Specialist falls under the broader career category of Medical Records and Health Information Technicians. ... Process, maintain, compile, and report patient information for health requirements and standards in a manner consistent with the healthcare industry's numerical coding system.

Patient Information Create forms that require the patient's name, phone number, address, email address, date of birth, social security number, and any other identifying information you think would be valuable. Sometimes a parent will need to release medical information on behalf of their child.

an expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure. HIPAA does not impose any specific time limit on authorizations. For example, an authorization could state that it is good for 30 days, 90 days or even for 2 years.

The authorization form is a device by which one medical provider can get a patient's permission to release their health or medical data to another provider or organization. ... A patient must sign the authorization form to give permission for someone new to receive or view the sensitive information.

The Health Insurance Portability and Accountability Act of 1996 was put in place to help ensure the privacy and ease of access of your medical records. A HIPAA authorization form is a document in that allows an appointed person or party to share specific health information with another person or group.

Description of PHI to be used or disclosed (identifying the information in a specific and meaningful manner). The name(s) or other specific identification of person(s) or class of persons authorized to make the requested use or disclosure. ... Description of each purpose of the requested use or disclosure.

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.