King Washington Authorization for Disclosure of Psychotherapy Notes to Law Firm

State:
Multi-State
County:
King
Control #:
US-AG06
Format:
Word; 
PDF; 
Rich Text
Instant download

Description

This form is for use and/or disclosure of the specific personally identifiable health information identified in form, specifically Psychotherapy Notes, pursuant to the requirements of 45 C.F.R. Sect 164.508, which sets out the federal privacy regulations for the Health Insurance Portability and Accountability Act of 1996 and authorizes the Covered Entity identified in the form to release the personally identifiable health information specifically referenced in th form.

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King Washington Authorization for Disclosure of Psychotherapy Notes to Law Firm