This form authorizes the release of plaintiff's confidential medical records to plaintiff's attorney.
Mississippi Authorization to Release Confidential Records
State:
Multi-State
Control #:
US-PI-0312
Format:
Word;
Rich Text
Instant download
Description
How to fill out Authorization To Release Confidential Records?
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FAQ
Mississippi law states that medical records are the property of the entity that produced them, like a doctor's office, hospital, or after hours clinic. The patient, however, has the right to inspect and obtain a copy of the records during regular business hours.
Requests may be mailed, hand delivered, transmitted via facsimile to (601) 359-1499, or emailed to publicrecords@sos.ms.gov. All requests will be answered within the statutory guidelines of the Mississippi Public Records Act and Administrative Procedures of the Office of the Mississippi Secretary of State.
Patient records should be maintained a minimum of seven (7) years from the date of LAST treatment. Refer to Board Regulation 53.
The Public Records Act ensures public access to public records in the possession of governmental entities in Mississippi.
compliant HIPAA release form must, at the very least, contain the following information: A description of the information that will be used/disclosed. The purpose for which the information will be disclosed. The name of the person or entity to whom the information will be disclosed.
Any licensee shall charge no more than Twenty-five Dollars ($25.00) for executing a medical record affidavit, when the affidavit is requested by the patient or the patient=s representative.
Vital records may be provided to the person that is the subject of a record or to family members or legal representatives under appropriate circumstances. Personal medical records from visits to our county clinics must be obtained through our Epic service: call 601-576-7267.
Looking up the criminal records of the state of Mississippi is relatively easy. The Mississippi Department of Corrections (MDOC) has a database and a search engine available to anyone who is interested in checking the conviction history of any subject.
