Pursuant to 45 CFR § 164.502(g), a person may receive medical records on behalf of another person. There are three (3) options: Health Care Power of Attorney – Can be used by anyone to put someone else in charge of managing their medical needs only if the patient is unable to speak for themselves. Minor Power of Attorney (Child) – Also known as a ”consent form,” which allows a family member, friend, or guardian to take responsibility for educational, medical, and day-to-day decisions. A person, such as an actual agent (or ”agent”) mentioned in a medical power of attorney (also known as a ”precautionary order”), generally has the authority to obtain medical records. In addition, any person appointed by a court to serve as a guardian or guardian must attach the judgment, order, or decree to the HIPAA release form. If you want patient records to be published at the patient`s request, check the first box. If there is a specific catalyst that opens the patient`s records, check the second box (”Other”) and describe this reason in the empty field provided. If the disclosing party needs to be able to contact the patient for marketing purposes, check the third box. If the disclosing party is able to share the patient`s health information with third parties for a fee, check the last box on this list. Next, the patient must determine and report when the disclosing party`s right to share their medical records must end. If the patient wants this authorization to end on a specific date, check the first box and enter this calendar date in the blank line after the words ”The (date)”. The patient can also set a specific event to terminate access to the patient`s medical records by checking the second box and the catalyst event in the blank line after the words ”.
The following event occurs. The following statement in bold (”The purpose of this permission is”) is followed by a list of statements (each with a check box). Check the box that applies to the catalyst or the reason why the patient`s medical records should be published. Yes, but it depends on the doctor`s office. In general, small offices generally do not charge a fee for copying and transferring medical records to another office. If the doctor`s office charges a fee, it must not exceed the maximum limit in the state (see table below). Locate the box labeled ”I. Authorization.” Use the first empty line in this section to designate the person (the disclosing party) who is authorized to disclose the patient`s medical records through those records and the Health Insurance Portability and Accountability Act, 1996.
Make sure that the name of this disclosing party is indicated exactly as it appears on their identification documents (for example. B driving licence). In most cases, additional information is needed to fully identify the patient. Enter their date of birth in the ”Date of Birth” line with their Social Security number in the empty field labeled ”SSN”. 4 – Report the type of information your agent can receive, use and submit When sending the letter to the medical institution, it is best to ask how the file should be sent, para. B example an electronic document (PDF, Word), a USB key, a CD, etc. The medical institution may charge a fee for sending the records, although it is prohibited from charging a fee for processing the application. If the patient wants all of their medical information to be provided by the aforementioned disclosing party, check the first box. If the patient only wants information relevant to a particular topic to be shared by the disclosing party, check the second box and indicate the type of information that appears in the blank line after the words ”. with regard to treatment or condition. If the patient only wants medical records created for their health care during a certain period of time to be shared, check the third box. Of course, you need to specify a start date for this period and an end date.
Use the two empty lines to save these dates in this order. If the disclosing party is only to use the patient`s medical records according to criteria other than those mentioned above, check the fourth box, then use the blank line labeled ”Other” to give a full description of what the agent can and/or cannot access. Look for the statement in bold associated with the phrase ”The above part may disclose…” Next, list the legal name of the entity for which the patient authorizes their medical record. In addition to the name of this entity, you must enter its ”Address”, ”City”, ”State”, ”Zip”, ”Telephone”, ”Fax” and ”E-mail” in the appropriately labeled blank lines. If other entities need to be listed here, you can use the software you use to enter information to insert more rows just below this area. If you are completing this form by hand, be sure to cite a properly titled (dated and signed) appendix that contains the entities authorized to receive the patient`s medical information. .
