Form ODM03397 Authorization for the Release or Use of Protected Health Information - Ohio

What Is Form ODM03397?

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

FAQ

Q: What is ODM03397?A: ODM03397 is a form used in Ohio to authorize the release or use of protected health information.

Q: Why would I need this form?A: You may need this form to give permission for the release or use of your protected health information by a healthcare provider or other entity.

Q: What information is required on the form?A: The form requires you to provide your personal information, specify the information to be released, indicate the purpose of the release, and provide your signature.

Q: Is this form specific to Ohio?A: Yes, ODM03397 is specifically used in Ohio.

Q: Can I use this form for any healthcare provider?A: Yes, you can use this form to authorize the release or use of your protected health information by any healthcare provider in Ohio.

Q: Is there a fee for using this form?A: There is usually no fee for using ODM03397, but some healthcare providers may charge a small administrative fee.

Q: How long is this form valid?A: The validity period of ODM03397 varies depending on the purpose of the release or use, but it is typically valid for one year.

Q: Can I revoke the authorization?A: Yes, you can revoke the authorization at any time by notifying the healthcare provider or entity in writing.

Q: Are there any restrictions on the use of this form?A: The use of ODM03397 is subject to state and federal laws governing the privacy and security of protected health information.