Authorization to Use and Disclose Protected Health Information - Utah

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Authorization to Use and Disclose Protected Health Information - Utah

Authorization to Use and Disclose Protected Health Information is a legal document that was released by the Utah Department of Health and Human Services - a government authority operating within Utah.

FAQ

Q: What is Protected Health Information?A: Protected Health Information (PHI) is any information about a person’s health status or healthcare that can be linked to an individual.

Q: Why do I need authorization to use and disclose PHI?A: Authorization is required to ensure that individuals have control over their own health information and to protect the privacy and confidentiality of medical records.

Q: Who can authorize the use and disclosure of PHI?A: The individual, or their legally authorized representative, must sign and provide written authorization for the use and disclosure of PHI.

Q: What information must be included in the authorization?A: The authorization must include a specific description of the information being disclosed, the purpose of the disclosure, the expiration date, and the individual's right to revoke the authorization.

Q: Is there a fee for authorizing the use and disclosure of PHI?A: No, there should not be a fee charged for authorizing the use and disclosure of PHI.

Q: Are there any exceptions to obtaining authorization for the use and disclosure of PHI?A: Yes, there are certain circumstances where authorization is not required, such as for treatment, payment, or healthcare operations, or when required by law.

Q: What are the consequences of unauthorized use or disclosure of PHI?A: The unauthorized use or disclosure of PHI can result in legal and financial consequences, including fines, penalties, and potential civil or criminal liability.

Q: Is my health information protected under state laws in Utah?A: Yes, Utah has state laws in place to protect the privacy of health information, in addition to federal laws, such as the Health Insurance Portability and Accountability Act (HIPAA).

Q: Can I revoke my authorization for the use and disclosure of PHI?A: Yes, you have the right to revoke your authorization for the use and disclosure of PHI at any time by providing a written revocation to the covered entity or individual who received the authorization.

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Form Details:

  • Released on April 28, 2015;
  • The latest edition currently provided by the Utah Department of Health and Human Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Utah Department of Health and Human Services.

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