DOEA Form 182 Authorization to Use or Disclose Health Information - Florida

DOEA Form 182 Authorization to Use or Disclose Health Information - Florida

What Is DOEA Form 182?

This is a legal form that was released by the Florida Department of Elder Affairs - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 182?
A: Form 182 is the Authorization to Use or Disclose Health Information form in Florida.

Q: What is the purpose of Form 182?
A: The purpose of Form 182 is to authorize the use or disclosure of an individual's health information.

Q: Who needs to fill out Form 182?
A: The individual whose health information is being disclosed or used needs to fill out Form 182.

Q: When is Form 182 used?
A: Form 182 is used when an individual wants to give permission for their health information to be shared with others.

Q: How should Form 182 be filled out?
A: Form 182 should be filled out completely and accurately, including the specific information about what health information can be disclosed and to whom.

Q: Is there a fee to submit Form 182?
A: No, there is no fee to submit Form 182.

Q: How long is Form 182 valid for?
A: Form 182 is usually valid for 90 days, but it can have a different duration depending on the specific circumstances.

Q: Can I revoke a previously signed Form 182?
A: Yes, you can revoke a previously signed Form 182 at any time by notifying the healthcare provider in writing.

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Form Details:

  • Released on April 1, 2003;
  • The latest edition provided by the Florida Department of Elder Affairs;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of DOEA Form 182 by clicking the link below or browse more documents and templates provided by the Florida Department of Elder Affairs.

Download DOEA Form 182 Authorization to Use or Disclose Health Information - Florida

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