New Mexico Formulario de liberación de Hippa para un niño menor de edad - Hippa Release Form for Minor Child

• Category: Comunicados - Médico - Arizona
• State: Multi-State
• Control #: US-01505BG-5
• Format: Word

Description

In response to growing concerns about keeping health information private, Congress passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The legislation includes a privacy rule that creates national standards to protect individuals' personal health information. A New Mexico HIPAA release form for a minor child allows parents or legal guardians to authorize the disclosure of their child's protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). This medical release form ensures that healthcare providers, insurance companies, or other authorized entities can obtain and share necessary health information about the minor to provide appropriate care or coordinate healthcare services. The New Mexico HIPAA release form for a minor child typically contains the following components: 1. Child's Information: Full name, date of birth, gender, and contact details of the minor child. 2. Parent/Legal Guardian Information: Full name, address, phone number, and relationship with the child. 3. Purpose of Authorization: A clear explanation of the specific reasons for authorizing the disclosure of the child's PHI, which may include medical treatment, insurance claims, or participation in research studies. 4. Authorized Recipients: Identification of the healthcare providers, insurance companies, or other individuals/entities that are permitted to access or receive the child's health information. 5. Duration of Authorization: The period during which the consent is valid, which can be specified by either a specific date or an event (e.g., termination of treatment or research study). 6. Revocation Procedure: Information stating that the parent or legal guardian has the right to revoke or cancel the authorization at any time, and the procedure to do so. 7. Signature and Date: Signature of the parent or legal guardian and the date of signing the form. Variations of the New Mexico HIPAA release form for minor children may include specific provisions for different healthcare settings or contexts, such as: 1. School-Based Health Centers: This type of form may have additional sections addressing the release of PHI to school nurses or counselors for administering healthcare during school hours. 2. Emergency Medical Treatment: A modified version could be used to consent to the disclosure of PHI in emergency situations where parents or legal guardians may not be readily available. 3. Mental Health Treatment: A specialized form may focus on authorizing the release of PHI related to mental health treatment, therapy, or counseling. Note: It is important to consult with a healthcare attorney or legal professional when creating or using a New Mexico HIPAA release form for a minor child to ensure compliance with state and federal regulations.

A New Mexico HIPAA release form for a minor child allows parents or legal guardians to authorize the disclosure of their child's protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). This medical release form ensures that healthcare providers, insurance companies, or other authorized entities can obtain and share necessary health information about the minor to provide appropriate care or coordinate healthcare services. The New Mexico HIPAA release form for a minor child typically contains the following components: 1. Child's Information: Full name, date of birth, gender, and contact details of the minor child. 2. Parent/Legal Guardian Information: Full name, address, phone number, and relationship with the child. 3. Purpose of Authorization: A clear explanation of the specific reasons for authorizing the disclosure of the child's PHI, which may include medical treatment, insurance claims, or participation in research studies. 4. Authorized Recipients: Identification of the healthcare providers, insurance companies, or other individuals/entities that are permitted to access or receive the child's health information. 5. Duration of Authorization: The period during which the consent is valid, which can be specified by either a specific date or an event (e.g., termination of treatment or research study). 6. Revocation Procedure: Information stating that the parent or legal guardian has the right to revoke or cancel the authorization at any time, and the procedure to do so. 7. Signature and Date: Signature of the parent or legal guardian and the date of signing the form. Variations of the New Mexico HIPAA release form for minor children may include specific provisions for different healthcare settings or contexts, such as: 1. School-Based Health Centers: This type of form may have additional sections addressing the release of PHI to school nurses or counselors for administering healthcare during school hours. 2. Emergency Medical Treatment: A modified version could be used to consent to the disclosure of PHI in emergency situations where parents or legal guardians may not be readily available. 3. Mental Health Treatment: A specialized form may focus on authorizing the release of PHI related to mental health treatment, therapy, or counseling. Note: It is important to consult with a healthcare attorney or legal professional when creating or using a New Mexico HIPAA release form for a minor child to ensure compliance with state and federal regulations.

Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.