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This document is an authorization form for student-athletes at New Mexico Junior College to disclose their protected health information related to their participation in intercollegiate athletics

How to fill out student-athlete authorizationconsent for disclosure

How to fill out Student-Athlete Authorization/Consent for Disclosure of Protected Health Information

1. Obtain the Student-Athlete Authorization/Consent form from the relevant authority or website.
2. Read the instructions carefully to understand the purpose of the form.
3. Fill in the student-athlete's personal information, including name, contact details, and team information.
4. Indicate the specific health information that can be disclosed.
5. Identify the individuals or organizations that are authorized to receive the health information.
6. Sign and date the form. Ensure that both the student-athlete and a parent or guardian (if applicable) sign it.
7. Submit the completed form to the appropriate office or individual as instructed.

Who needs Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

1. Student-athletes who participate in sports programs at educational institutions.
2. Trainers and coaches who require access to health information for training and medical purposes.
3. Healthcare providers who need authorization to share a student-athlete's health information with the institution.

People Also Ask about

Does FERPA apply to college athletes?

As sports reporters, you are reporting on student athletes, of course. They are no different from other students under FERPA. However, they are under more scrutiny and university oversight.

Are athletic trainers bound by HIPAA?

HIPAA and athletic medical staff HIPAA applies to athletic medical staff, including athletic trainers, when they work for covered entities that engage in electronic healthcare transactions.

Are college athletes protected under HIPAA?

If a health care professional or paraprofessional such as a certified athletic trainer is a covered entity, HIPAA will prevent the disclosure of private health information to third parties such as conference offices and the media without authorization from the student-athlete.

Does HIPAA apply to college athletes?

The NCAA News The HIPAA Privacy Rule addresses the latter point. It says that the HIPAA definition of "protected health information" does not apply to a student's college or university education records. Those records are instead protected by FERPA.

What are the authorization requirements for use and disclosure of protected health information?

A covered entity may not use or disclose protected health information, except either: (1) as the Privacy Rule permits or requires; or (2) as the individual who is the subject of the information (or the individual's personal representative) authorizes in writing.

What is a valid authorization for disclosure of health information?

The core elements of a valid authorization include: A meaningful description of the information to be disclosed. The name of the individual or the name of the person authorized to make the requested disclosure. The name or other identification of the recipient of the information.

Does HIPAA apply to college students?

HIPAA explicitly excludes these records if they are part of a student's educational file, even if created by healthcare providers. A university clinic's treatment records for non-students fall under HIPAA, while student records are FERPA-protected.

How to fill out authorization to disclose protected health information?

How do I fill out a HIPAA release form? Provide instructions. Name the patient and individual authorized to use or disclose their PHI. Describe the information. Specify recipients. Specify the purpose of disclosure. Specify the time period. Detail their revocation rights. Obtain the patient's signature.

For pdfFiller’s FAQs

What is Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

Student-Athlete Authorization/Consent for Disclosure of Protected Health Information is a formal document that allows student-athletes to grant permission for their health-related information to be shared with specific individuals or organizations, typically related to their athletic program or medical care.

Who is required to file Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

Typically, student-athletes participating in intercollegiate athletics are required to file this authorization to ensure that their health information can be shared with coaches, trainers, and medical staff involved in their care.

How to fill out Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

To fill out the authorization, the student-athlete must provide their personal information, detail the specific health information to be disclosed, list the entities authorized to receive this information, and sign and date the form to give consent.

What is the purpose of Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

The purpose of this authorization is to ensure that student-athletes’ health information can be managed effectively and shared appropriately among the necessary parties for their care, compliance, and athletic performance.

What information must be reported on Student-Athlete Authorization/Consent for Disclosure of Protected Health Information?

The information that must be reported includes the student-athlete's name, identification information, the specific health information to be disclosed, the purpose of the disclosure, the names of entities receiving the information, and a clear indication of consent through signature.