Get the free Release PHI Form - from Mental Health.doc - yalehealth yale
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Mental Health & Counseling PO Box 208237 New Haven, CT 06520-8237 Phone: 203-432-0290 Fax: 203-432-8458 AUTHORIZATION FOR RELEASE OF MENTAL HEALTH RECORD (Also known as Protected Health Information)
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What is release phi form?
The release phi form is a document used to authorize the disclosure of protected health information (PHI) to a third party.
Who is required to file release phi form?
A person or entity that needs to share an individual's PHI with a third party must file the release phi form.
How to fill out release phi form?
To fill out the release phi form, you need to provide your personal information, specify the purpose of the disclosure, identify the recipient of the PHI, and sign the form.
What is the purpose of release phi form?
The purpose of the release phi form is to ensure that individuals have control over the sharing of their PHI and to comply with privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA).
What information must be reported on release phi form?
The release phi form typically requires information such as the individual's name, contact information, the specific PHI to be disclosed, the purpose of the disclosure, and the recipient's identity.
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