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This document serves as an authorization form for releasing protected health information for patients to the University of Michigan WorkConnections.
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What is authorization to release patient?
Authorization to release patient is a legal document that allows healthcare providers to share a patient's health information with a third party, such as another healthcare provider or insurance company.
Who is required to file authorization to release patient?
The patient or their legal representative is required to file the authorization to release patient.
How to fill out authorization to release patient?
To fill out an authorization to release patient, the patient or legal representative needs to provide their personal information, specify the healthcare information to be released, indicate the recipient of the information, and sign/date the document.
What is the purpose of authorization to release patient?
The purpose of authorization to release patient is to ensure the privacy and confidentiality of a patient's health information while allowing the necessary sharing of information for appropriate healthcare purposes.
What information must be reported on authorization to release patient?
The authorization to release patient must include the patient's personal information (e.g., name, date of birth), the specific health information to be released, the name/address of the recipient, the purpose of the release, and the patient's signature/date.
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