Form 99 Authorization for the Use / Disclosure of Protected Health Information - Mississippi

What Is Form 99?

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

FAQ

Q: What is Form 99?A: Form 99 is the Authorization for the Use/Disclosure of Protected Health Information.

Q: Who uses Form 99?A: Form 99 is used by individuals in Mississippi to authorize the use or disclosure of their protected health information.

Q: What is protected health information?A: Protected health information refers to any health information that is individually identifiable and is protected under federal privacy laws.

Q: Why would someone need to complete Form 99?A: Someone may need to complete Form 99 to grant permission for their health information to be used or disclosed for certain purposes, such as for treatment, payment, or healthcare operations.

Q: Are there any fees associated with completing Form 99?A: There are typically no fees associated with completing Form 99, but you should confirm this with your healthcare provider.

Q: How long is Form 99 valid for?A: The validity of Form 99 may vary depending on the specific circumstances and requirements outlined by your healthcare provider.

Q: Can I revoke my authorization on Form 99?A: Yes, you can revoke your authorization on Form 99 at any time by submitting a written request to your healthcare provider.

Q: Is completing Form 99 mandatory?A: Completing Form 99 is not mandatory, but it may be required in certain situations, such as when granting permission for the use or disclosure of your health information.

Q: Can I amend the information on Form 99?A: You may be able to amend the information on Form 99 by submitting a written request to your healthcare provider, but this may be subject to their policies and procedures.