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PATIENT:All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232.NICKNAME/MAIDEN NAME/OTHER:HEALTH RECORD NO.:Consent

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How to fill out consent to verbally disclose

01

Write down your personal information such as name, address, and contact details.

02

State the name of the person or organization that you are giving consent to disclose information to verbally.

03

Specify the type of information that can be disclosed verbally.

04

Sign and date the consent form.

Who needs consent to verbally disclose?

01

Anyone who wants their personal information to be disclosed verbally to a specific person or organization needs to fill out a consent form.

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What is consent to verbally disclose?

Consent to verbally disclose refers to an individual's permission granted to share their personal information through verbal communication, ensuring confidentiality and compliance with privacy regulations.

Who is required to file consent to verbally disclose?

Individuals or organizations that handle sensitive personal information and wish to share that information verbally with third parties are required to file consent to verbally disclose.

How to fill out consent to verbally disclose?

To fill out consent to verbally disclose, you need to provide the individual's name, the specific information to be disclosed, the purpose of the disclosure, and obtain the individual's signature and date.

What is the purpose of consent to verbally disclose?

The purpose of consent to verbally disclose is to protect the individual's privacy by ensuring that their information is shared only with their explicit permission, thus complying with legal and ethical obligations.

What information must be reported on consent to verbally disclose?

The information that must be reported includes the individual's identifying information, the type of information to be disclosed, the purpose of the disclosure, the names of the entities involved, and the date of consent.

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