Search results with tag "Disclose protected health"
Record Request: Authorization to Use and Disclose ...
ufhealth.orgRecord Request: Authorization to Use and Disclose Protected Health Information (“PHI”) Maintained by UF Health* Patient’s Name Date of Birth Medical Record # From the doctor, office, facility of other health care provider checked or written below: To the facility / person below: Name of Representative Relationship to Patient Legal Authority
NH Authorization to Disclose Protected Health or Billing ...
www2.novanthealth.orgCFR Part 2), genetic information, HIV/AIDS, and other sexually transmitted diseases, unless limited by the above selections. Once my health information is released, the recipient may disclose or share my information with others and my information may no longer be protected …
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES …
www.governor.ny.govWe may use and disclose Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations without your written permission, in most cases. Examples of the uses and disclosures that NYSDOH VS, as a health care provider, may make for these purposes include the following:
Authorization to Use or Disclose Protected Health …
www.lifespan.orgRhode Island Hospital / Hasbro Children’s Hospital . Health Information Management Department . 593 Eddy Street . Providence, R.I. 02903 . Tel: 401.444.4040 ; Fax ...
Authorization for Kaiser Permanente to Use/Disclose ...
info.kaiserpermanente.orgHow to fill out “Authorization for Kaiser Permanente to Use/Disclose Protected Health Information” form Member must complete this section. If not complete, form may be sent back to you. Complete each box as indicated with the following information: • Patient’s Name (Print clearly) • Other names the patient has used.