Wake North Carolina Formulario de liberación de Hippa para padres - Hippa Release Form for Parents

State:
Multi-State
County:
Wake
Control #:
US-01505BG-1
Format:
Word
Instant download

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.

The Wake North Carolina HIPAA Release Form for Parents is a legally binding document that allows parents or legal guardians to authorize the release of their child's protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). This HIPAA release form is specifically designed for parents residing in Wake County, North Carolina, and provides them with the ability to grant consent for their child's healthcare providers to share and discuss their medical records with designated individuals or organizations. This form ensures that parents have control and access to their child's health information when necessary, while also maintaining their child's privacy and confidentiality. The Wake North Carolina HIPAA Release Form for Parents typically requires the following information: 1. Parent/Guardian Information: Name, address, contact details. 2. Child's Information: Name, date of birth, assigned medical record number. 3. Authorized Individuals: Names and relationships of the individuals or organizations authorized to have access to the child's PHI. 4. Purpose of Disclosure: Reason for releasing the child's health information. 5. Effective Date and Expiration Date: Specifies the period during which the form is valid. 6. Parent/Guardian Signature: Signatures of all legally authorized parents or guardians. There may be different types of Wake North Carolina HIPAA Release Forms for Parents, depending on the specific purpose of the disclosure. For example, there could be separate forms for authorizing information release to specific healthcare providers, schools, insurance companies, or other relevant parties involved in the child's care. By using the Wake North Carolina HIPAA Release Form for Parents, parents can ensure that essential medical information about their child can be readily accessed and shared when needed, while also upholding the privacy rights and confidentiality of their child's health records.

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.
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Please download, print and fill out the registration form, Health History Form, and Medical Records Release Form prior to your appointment. All patients please complete Registration, Health Questionnaire and Office Policies.It differs from other parts of the hospital, like the general medical floors. Must complete all other pages on the WCPSS PreParticipation Form. Completed Authorization for Release of Patient Record form (form may be completed in the office). Final signature must be done in the office. Please fill out the form below or download the Adult Medical History Form with the button above and fill it out at your convenience. If you need assistance in completing this form, please let us know so that we can assist you. Medical news and health news headlines posted throughout the day, every day.

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Wake North Carolina Formulario de liberación de Hippa para padres