This form is a Statutory Authorization for the Release of Medical Information. The named patient authorizes his/her treating medical professionals to communicate with and to release to his/her attorney all medical information (including but not limited to that which involves treatment for alcohol or drug abuse, and emotional problems) records, reports, notes and billing and financial statements maintained while the patient was being treated on any date.
Minneapolis Minnesota Statutory Authorization for Release of Medical Information
Category:
State:
Minnesota
City:
Minneapolis
Control #:
MN-8393D
Format:
Word;
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FAQ
A violation is an unauthorized disclosure that results in the conclusion there is a low probability of compromise to the PHI. If this low risk is determined and supported by the Risk Assessment, reporting the incident to the OCR and the involved patient is deemed to be unnecessary.
Unauthorized access to patient medical records occurs when an individual who lacks authorization, permission, or other legal authority, accesses data, including protected health information (PHI), contained in patient medical records.
The current Minnesota Health Records Act (MHRA) was enacted by the Minnesota Legislature in 2007 and regulates the use and disclosure of health records in Minnesota.
Minnesota Rules 1205.1400, subpart 3, requires that individuals giving informed consent have sufficient mental capacity to understand the consequences of their decision to give consent. Minnesota Rules 1205.1400, subpart 4, requires that a valid informed consent must: Be voluntary and not coerced. Be in writing.
The collection, use or disclosure of personal health information without the consent of individuals and for purposes that are not permitted or required by the Personal Health Information Protection Act (PHIPA) is commonly referred to as unauthorized access, or ?snooping.? Unauthorized access includes the viewing of
How you make your request will depend on your provider's processes. 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.
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.
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.
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.
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.