Contra Costa California Authorization for Disclosure of Medical Information

State:
California
County:
Contra Costa
Control #:
CA-JM-0020
Format:
Word
Instant download

Description

This form is used to authorize the company to obtain results of an employee's drug or alcohol tests or other medical tests.

The Contra Costa California Authorization for Disclosure of Medical Information is an important legal document that grants permission to healthcare providers to release an individual's medical information to authorized parties. This authorization ensures compliance with privacy regulations outlined by the Health Insurance Portability and Accountability Act (HIPAA) and enables the lawful sharing of sensitive medical information for various purposes. One of the commonly used types of Contra Costa California Authorization for Disclosure of Medical Information is the "General Authorization for Disclosure of Medical Information." This comprehensive form allows medical providers to disclose a patient's medical records, diagnostic reports, lab results, treatment history, and other relevant information to third parties as needed. It is often used when transferring medical records to new healthcare providers or when collaborating with other professionals involved in the patient's care. Another type of Contra Costa California Authorization for Disclosure of Medical Information is the "Limited Authorization for Disclosure of Medical Information." This form allows individuals to specify the specific types of medical information they authorize to be disclosed, as well as the designated recipients. This type of authorization is commonly used when individuals want to grant access to certain medical records or test results to specific parties, such as insurance companies or legal representatives. Moreover, the "Minor Authorization for Disclosure of Medical Information" is another type of Contra Costa California Authorization, specifically designed for minors under the age of 18. This form requires parental or guardian consent and empowers healthcare providers to disclose the minor's medical information to authorized individuals or organizations involved in their care, in accordance with their best interest. When completing any of the above-mentioned Contra Costa California Authorizations for Disclosure of Medical Information, it is crucial to provide accurate and detailed information. This includes the individual's full name, contact information, the specific medical information being disclosed, the purpose of the disclosure, and the duration for which the authorization remains valid. The authorized party must also be clearly identified, whether it is a specific individual, company, or organization. Overall, the Contra Costa California Authorization for Disclosure of Medical Information plays a fundamental role in ensuring the privacy, security, and lawful sharing of an individual's medical records. By utilizing the appropriate type of authorization form and providing the necessary details, healthcare providers can maintain compliance with HIPAA regulations while supporting the continuity of care and facilitating effective communication between authorized parties.

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FAQ

Contra Costa Health Plan (CCHP) was the first federally qualified, state licensed, county sponsored HMO in the United States. CCHP has been serving the health needs of people in Contra Costa County for over 45 years, and now serves over 227,000 people.

The patient's legal name, date of birth, gender, Social Security number, address, telephone number, guarantor, subscriber, or next-of-kin are key identifying elements that assist in establishing the proper individual.

Medi-Cal provides medical, dental, and vision insurance to low-income families in California.

Chiropractic services are covered and reimbursable by Medi-Cal when provided by FQHCs and RHCs, as mandated by California Association of Rural Health Clinics, et al.

Contra Costa Health Plan (CCHP) has a Medi/Cal contract with the California Department of Health Care Services (DHSC).

You may be able to request your record through your provider's patient portal. You may have to fill out a form ? called a health or medical record release form, or request for access?send an email, or mail or fax a letter to your provider.

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.

If you would like information on how to change provider organizations, please call Contra Costa Health Plan member services at 1-877-661-6230 (Press 2) (TTY 1-800-735-2929), Monday through Friday, 8 a.m. to 5 p.m. We cover chiropractic services, limited to the treatment of the spine by manual manipulation.

An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

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I moved in or out of Contra Costa County, how do I transfer my case? Read about downloading files.Click on the icon below to download the appropriate file. United States. Congress.

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Contra Costa California Authorization for Disclosure of Medical Information