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Form BEN043 Authorization for the Use and / or Disclosure of Protected Health Information (Phi) - Alaska
What Is Form BEN043?
This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the BEN043 form?A: The BEN043 form is the Authorization for the Use and/or Disclosure of Protected Health Information (PHI) in Alaska.
Q: What is PHI?A: PHI stands for Protected Health Information, which includes personal health details that are protected under privacy laws.
Q: Who needs to use the BEN043 form?A: Anyone who wants to authorize the use or disclosure of their PHI in Alaska needs to use the BEN043 form.
Q: What is the purpose of the BEN043 form?A: The purpose of the BEN043 form is to obtain consent from individuals for the use and/or disclosure of their PHI in Alaska.
Form Details:
- Released on December 1, 2021;
- The latest edition provided by the Alaska Department of Administration;
- 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 fillable version of Form BEN043 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.
Download Form BEN043 Authorization for the Use and / or Disclosure of Protected Health Information (Phi) - Alaska
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