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Board of County Commissioners Department of Employee Services Individual Authorization for Use/Disclosure of Protected Health Information (PHI) (Please attach copies only. Do not attach original documents.)
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What is individual authorization for usedisclosure?
Individual authorization for usedisclosure is a form that allows an individual to give permission for their information to be disclosed to a specific party or for a specific purpose.
Who is required to file individual authorization for usedisclosure?
Individuals who wish to have their information disclosed to a specific party or for a specific purpose are required to file individual authorization for usedisclosure.
How to fill out individual authorization for usedisclosure?
Individuals can fill out individual authorization for usedisclosure by providing their personal information, specifying the recipient of the information, and indicating the purpose of the disclosure.
What is the purpose of individual authorization for usedisclosure?
The purpose of individual authorization for usedisclosure is to ensure that individuals have control over who has access to their personal information and for what purpose.
What information must be reported on individual authorization for usedisclosure?
Individual authorization for usedisclosure must include the individual's personal information, the recipient of the information, the purpose of the disclosure, and any limitations on the use of the information.
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