Things to Consider When Using a HIPPA Release Template

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PDF Template - hippa release form

When you need to obtain a HIPPA release form, accuracy is important. Before a health plan member’s personal health information (PHI) is disclosed for any reason which might run contrary to the HIPPA Privacy Rule, these releases must be obtained. Failure to have a properly signed authorization and then using the participant’s PHI would violate this rule and leave you facing serious financial penalties. In some instances, releasing such information could result in criminal charges.

Here is What You Will Find Here:

  • When a HIPPA Release Authorization Required
  • Important Things to Include on a HIPAA Authorization Form
  • Statements Which Must Be Included on the HIPPA Release Form
  • Best Practices for HIPPA Release Authorization Forms
  • Additional HIPPA Related Resources

When is a HIPAA Authorization Required?

Not every situation demands a HIPPA release authorization which is what makes a HIPPA release form template a must-have document. These are the conditions under which a HIPPA release must be obtained:

  • When intending to use or disclose personal health information for non-face-to-face marketing purposes
  • Whenever there will be disclosure of psychotherapy notes that do not occur during treatments, payments, or the implementation of health care operations
  • When using or disclosing someone’s substance abuse treatment records
  • When the protected health information will be sold for marketing purposes
  • When conducting research if the personal health information will be used or disclosed

What Important Things Should be Included on a HIPAA Authorization Form?

To ensure the proper language is included, you should look for the following language which is included in our HIPPA release form template:

  • Information which is intended to be used or disclosed
  • Identification of persons, or class of persons who can use or disclose information
  • Identification of any third parties who can use or disclose the information
  • A thorough description of the purpose of the disclosure or use of information
  • The date at which the authorization will expire or an event which will cause the expiration
  • Signature of person authorizing disclosure and date of signing

Statements Which Must Be Included on the HIPPA Release Form

The following acknowledgement must be made on any release form ensure when you are filling out a customized HIPPA release form template the signor is:

  • Acknowledging their right to revoke in writing only (at any time)
  • Acknowledging that the release of information prior to revocation is exempt from revocation
  • Acknowledgement that information may be disclosed to third parties as part of authorization
  • Acknowledging that there was no treatment withheld or payment of treatment withheld pending or dependent upon the signing of the authorization
  • Acknowledging that a copy, photocopy, or faxed copy of the authorization is as valid

Best Practices for HIPPA Release Authorization Forms

It is important to make sure the person signing the release understands their rights. The release authorization should be written in plain English so there is no doubt what they are signing. The following items must also be covered:

  • Right to revoke — explain clearly how to revoke the right to release. This must always be done in writing.
  • Exceptions to revocation — make it clear that information disclosed prior to revocation cannot be “reclaimed”
  • Provide copy to signor — make sure the signor is given a copy of the authorization which they have signed.
  • Always have an end date — there should always be an expiration date on an authorization. If you are using a HIPPA release form template for a study, you may want to use the “end of the study” as the triggering event for expiration.
  • When signed by authorized representative — a full description of the party’s authority to act on behalf of the persons who is having their records disclosed is imperative (i.e. child, ward, attorney, etc.).

Ensuring the Legality of Your HIPPA Authorization Form

Every legal contract requires a signature and date. Obtaining these signatures can often be challenging, especially when you are not in the same office with someone. Not being in close proximity geographically can also inhibit the proper execution of your completed HIPPA release form template. We have a solution!

When it's time to get the HIPPA release form template signed, you can use Nitro Sign! NitroSign offers immediate, secure signing and both parties will have copies of the contract available to them immediately.

Additional HIPPA Related Resources

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