Search results with tag "Of protected health information"
AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH …
www.dhcs.ca.govDEPARTMENT OF HEALTH CARE SERVICES PRIVACY OFFICE . AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION . I, (Name of patient) , hereby authorize (Name of person or facility which has information) to. release the following health information: To: (Name and title or facility name to receive health information) (Street address, city, state ...
AUTHORIZATION TO DISCLOSE PROTECTED HEALTH …
eforms.comof protected health information. Covered entities as that term is defined by HIPAA and Texas Health & Safety Code § 181.001 must obtain a signed authorization from the individual or the individual’s legally authorized representative to electronically disclose that indi-vidual’s protected health information. Authorization is not required for
Authorization For Use/Disclosure of Protected Health ...
www.piedmont.org35256P Rev. 10/16 Authorization For Use/Disclosure of Protected Health Information PATIENT INFORMATION The following information is needed to assist the provider in locating the patient’s records:
LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH ...
lacdmh.lacounty.govlos angeles county department of mental health authorization for use or disclosure of protected health information mh 602 (09/2016) page 1 of 2