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Authorization for Disclosure, Use, or Receipt of
Protected Health Information
(Note: For individuals receiving alcohol or drug abuse treatment, this form serves as the consent required by 42 CFR 2.31.)
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What is authorization for disclosure use?
Authorization for disclosure use is a legal document that gives permission for confidential information to be shared or disclosed.
Who is required to file authorization for disclosure use?
Any individual or organization that needs to share or disclose confidential information is required to file authorization for disclosure use.
How to fill out authorization for disclosure use?
Authorization for disclosure use can be filled out by providing details such as the purpose of disclosure, the information to be disclosed, the parties involved, and the expiration date of the authorization.
What is the purpose of authorization for disclosure use?
The purpose of authorization for disclosure use is to ensure that confidential information is shared or disclosed only with proper consent and for legitimate reasons.
What information must be reported on authorization for disclosure use?
Information such as the purpose of disclosure, the type of information being shared, the parties involved, and any restrictions on the disclosure must be reported on authorization for disclosure use.
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