Medical Authorization Form For Elderly Parents In Hennepin

State:
Multi-State
County:
Hennepin
Control #:
US-00426
Format:
Word; 
Rich Text
Instant download

Description

The Medical Authorization Form for Elderly Parents in Hennepin is designed to grant legal representatives access to an individual's medical information, facilitating smoother communications between healthcare providers and legal counsel. This form allows attorneys and other representatives to request complete medical records, including any treatment details, without restriction. Key features include HIPAA compliance, ensuring that the individual's health information is protected while providing necessary disclosure to the authorized attorney. Users must fill in personal details, including the date and name of the attorney, and indicate any specific health conditions or treatments authorized for disclosure. The form is essential for attorneys, partners, owners, associates, paralegals, and legal assistants as it streamlines the process of retrieving vital medical records needed for legal representation. Furthermore, the form also emphasizes the need for confidentiality, instructing healthcare providers not to share information without proper authority. This document can be particularly useful in cases involving insurance claims or personal injury lawsuits, ensuring that all relevant medical information is available for legal proceedings.
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FAQ

Get help. Call the Hennepin County Managed Health Care Office at 612-596-8860 for help with enrollment questions, billing questions, or complaints.

Sign in to My UNC Chart or the patient portal where you got care and request a copy of your medical records. Fill out an authorization form for medical records and drop it off at one of our locations in person. Fill out an authorization form for medical records and mail it to one of our locations.

You can call us at 612-873-3180 to inquire if your request has been processed and sent.

In 2018, HCMC became Hennepin Healthcare.

You may request your records on paper or in an electronic format. Fax your release form at 612-873-1516. In-person: For form drop-off, please leave your form in the black box near the office door of the Medical Records Office at Hennepin Healthcare.

Apply for health care assistance Most people can apply online at MNsure or call 1-855-366-7873. People 65+ and people with a disability: Download and complete an application and submit to Hennepin County.

Medicaid. A state and federal program (called Medical Assistance in Minnesota) that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults and people with disabilities.

To schedule an appointment by phone, call 612-873-6963, Monday through Friday am to pm. To schedule online, current patients can log into MyChart or create an account if you don't have one. If you are a new patient, please use our easy online scheduling portal.

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Medical Authorization Form For Elderly Parents In Hennepin