Get the free Student-Athlete Authorization/Consent for Disclosure of Protected Health Information

This document authorizes the disclosure of a student-athlete's protected health information to the NCAA and its affiliates for the purposes of health and safety monitoring 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 your athletic department or school website.
2. Provide personal information such as your name, date of birth, and contact information at the top of the form.
3. Read the instructions carefully to understand what information you are consenting to disclose.
4. Sign and date the authorization section, ensuring to include your printed name.
5. If applicable, have a parent or guardian sign the form if you are underage.
6. Submit the completed form to the appropriate office within your athletic department.

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

1. Student-athletes who are participating in college or university sports programs.
2. Coaches and athletic staff who need access to a student-athlete's protected health information for training and event participation.
3. Athletic trainers and medical personnel involved in the care of student-athletes.

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?

It is a document that allows student-athletes to grant permission for the disclosure of their protected health information to specified individuals or organizations.

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

Student-athletes who wish to share their protected health information with coaches, medical staff, or other relevant parties are required to file this authorization.

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

The form typically requires the student-athlete's personal information, details of the information to be disclosed, the individuals or organizations authorized to receive it, and the student's signature acknowledging consent.

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

The purpose is to ensure that student-athletes can provide their consent for the release of their health information to necessary parties for the management of their health and participation in sports.

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

The form must include the athlete's name, date of birth, specific health information to be disclosed, names of individuals/entities allowed to access the information, and the duration of the consent.