Form DHHS-DAAS-9112 Resident Authorization Form - North Carolina

What Is Form DHHS-DAAS-9112?

This is a legal form that was released by the North Carolina Department of Health and Human Services - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DHHS-DAAS-9112 Resident Authorization Form?A: The DHHS-DAAS-9112 Resident Authorization Form is a document used in North Carolina to authorize the disclosure of protected health information of a resident in a long-term care facility.

Q: Who needs to complete the DHHS-DAAS-9112 Resident Authorization Form?A: The form should be completed by the resident or their legal representative.

Q: What is the purpose of the DHHS-DAAS-9112 Resident Authorization Form?A: The form allows the long-term care facility to disclose the resident's protected health information to third parties, such as family members or healthcare providers, with the resident's consent.

Q: Is the DHHS-DAAS-9112 Resident Authorization Form mandatory?A: No, completion of the form is voluntary, and the resident has the right to revoke their authorization at any time.