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Authorization for Release of Protected Health Information (HIPAA) Note: Any covered participant over the age of 18 requires a separate Authorization Form to be completed. I hereby authorize the use
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Protected Health Information (PHI) under HIPAA refers to any information in a medical record or other health information that can be used to identify an individual and that was created, used, or disclosed in the course of providing a healthcare service.
Healthcare providers, health plans, and healthcare clearinghouses are required to file protected health information under HIPAA.
Protected health information under HIPAA should be filled out carefully following the guidelines provided by the U.S. Department of Health and Human Services.
The purpose of the protected health information under HIPAA is to ensure the privacy and security of individuals' health information while allowing for the flow of health information necessary to provide high-quality healthcare.
Any information that can be used to identify an individual, such as names, addresses, dates of birth, social security numbers, medical records, and any other data that is related to an individual's health.
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