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Form DOH-5198 Authorization to Release Protected Medicaid Member Information to a Third Party - New York
What Is Form DOH-5198?
This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOH-5198?A: DOH-5198 is a form used in New York to authorize the release of protected Medicaid member information to a third party.
Q: Why would I need to use DOH-5198?A: You would need to use DOH-5198 if you want to grant permission for your protected Medicaid member information to be shared with a third party.
Q: Who can use DOH-5198?A: Any New York Medicaid member who wishes to authorize the release of their protected Medicaid member information to a third party can use DOH-5198.
Q: What information is considered protected Medicaid member information?A: Protected Medicaid member information may include medical records, treatment history, billing information, and other sensitive personal data.
Q: Can I choose which specific information to authorize for release?A: Yes, when using DOH-5198, you can specify which information you authorize for release to the third party.
Q: Are there any limitations or restrictions on the use of DOH-5198?A: Yes, there may be limitations or restrictions on the use of DOH-5198. It is important to read and understand the form and any accompanying instructions.
Q: Do I need to submit DOH-5198 in person?A: The submission process may vary, but in general, you may need to submit DOH-5198 in person or by mail to the appropriate office or department.
Q: Is there a fee associated with submitting DOH-5198?A: There is typically no fee associated with submitting DOH-5198, but it is advisable to check with the relevant office or department to confirm.
Q: How long does it take for the authorization to take effect?A: The timeframe for the authorization to take effect may vary. It is recommended to inquire about the processing time when submitting DOH-5198.
Form Details:
- Released on January 1, 2016;
- The latest edition provided by the New York State Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form DOH-5198 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
