Advertisement

Patient authorization forms

Published on: 

I'm about to open a family practice. Can you outline the elements of a HIPAA patient authorization form?

Q: I'm about to open a family practice. Can you outline the elements of a HIPAA patient authorization form?

A: Forms used to authorize record releases and other protected medical information must contain the following elements: (1) a description of the information to be released; (2) names of the people authorized to release it; (3) names of the recipients; (4) reasons for the disclosure (or, if your patient herself has initiated it, the phrase "at the request of the individual"); (5) an expiration date or terminating event (at the end of a research study, for example); (6) your patient's signature (or that of her personal representative, if so authorized); (7) the date the form was signed; (8) a statement that makes clear your patient's right to revoke her authorization at any time, and steps to accomplish this; (9) a statement noting that the information may be subject to redisclosure by the recipient, and thus no longer protected; and (10) depending upon the situation, a statement that makes clear that any treatment, payment, or benefits your patient receives aren't contingent on her signing the authorization.

Advertisement

Additionally, the authorization must be written in plain language and a patient copy provided, if she wasn't the one initiating the authorization.

Advertisement
Advertisement