Get the free Authorization for Verbal Communication of Protected Health Information - monroeclinic

This document authorizes Monroe Clinic and Hospital to discuss a patient’s health information verbally with specific family members or individuals involved in the medical care, while ensuring confidentiality

How to fill out authorization for verbal communication

How to fill out Authorization for Verbal Communication of Protected Health Information

1. Begin with the patient's full name and date of birth at the top of the form.
2. Clearly indicate the purpose of the authorization, specifying the verbal communication of protected health information.
3. List the specific individuals or entities authorized to communicate with in the section provided.
4. Specify the protected health information that can be disclosed verbally.
5. Include the effective dates of the authorization — when it begins and when it expires.
6. Ensure the patient or legally authorized representative signs and dates the form.
7. Offer a copy of the signed authorization to the patient for their records.

Who needs Authorization for Verbal Communication of Protected Health Information?

1. Patients who want to allow healthcare providers to discuss their health information verbally with designated persons.
2. Family members, caregivers, or others who need access to a patient's health information for coordination of care.
3. Healthcare providers who require explicit permission to share patient information with others.

People Also Ask about

How to write an authorization to release information?

Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.

What is an authorization to use or disclose protected health information?

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

Is verbal communication protected by HIPAA?

The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral.

How would you use verbal communication in healthcare?

Guiding Verbal Communications Principles Create a safe and respectful environment. Greet your patients warmly. Use speech that is easy to understand. Speak slower than usual. Engage your patients. Use pictures, physical models, or videos to illustrate technically complex topics. Confirm understanding.

What is an authorization for disclosure of protected health information?

Under the HIPAA Privacy Rule, healthcare providers, health plans, business associates, and others involved in administration of healthcare, may not share a patient's protected health information (PHI) without that patient's written authorization.

For pdfFiller’s FAQs

What is Authorization for Verbal Communication of Protected Health Information?

Authorization for Verbal Communication of Protected Health Information is a formal consent required from a patient allowing healthcare providers to discuss their health information verbally with specified individuals.

Who is required to file Authorization for Verbal Communication of Protected Health Information?

Healthcare providers and organizations who wish to share a patient's protected health information verbally with third parties must file this authorization.

How to fill out Authorization for Verbal Communication of Protected Health Information?

To fill out the authorization, the patient must provide their personal details, specify the individuals to whom the information may be disclosed, the nature of the information to be shared, and sign and date the document.

What is the purpose of Authorization for Verbal Communication of Protected Health Information?

The purpose is to protect the patient's privacy while allowing for necessary communication of health information among clinicians, caregivers, or family members.

What information must be reported on Authorization for Verbal Communication of Protected Health Information?

The form must include the patient's name, the names of individuals authorized to receive information, the specific information to be disclosed, purpose of disclosure, expiration date of the authorization, and the patient's signature.