HIPAA Authorization to Use and Disclose PHI | Practical Law

HIPAA Authorization to Use and Disclose PHI | Practical Law

A sample form to be provided by an individual to a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (for example, a group health plan or health provider) authorizing the covered entity to use or disclose the individual's protected health information (PHI) for certain purposes. This authorization is designed to comply with HIPAA's requirements, but does not address applicable state law requirements. This Standard Document has integrated notes and important explanations and drafting tips.

HIPAA Authorization to Use and Disclose PHI

Practical Law Standard Document 6-502-5460 (Approx. 15 pages)

HIPAA Authorization to Use and Disclose PHI

by Practical Law Employee Benefits & Executive Compensation
Maintained • USA (National/Federal)
A sample form to be provided by an individual to a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (for example, a group health plan or health provider) authorizing the covered entity to use or disclose the individual's protected health information (PHI) for certain purposes. This authorization is designed to comply with HIPAA's requirements, but does not address applicable state law requirements. This Standard Document has integrated notes and important explanations and drafting tips.