Policy Manual


Written Authorizations for Use and Disclosure of Protected Health Information      

Type: Policy                 Category: General                 Level: Community Care 

Parties: Community Care employees and contractees

Printer Friendly Version: http://apps.comcareme.org/policymanual/default.aspx?code=1.ME.67&nonav=yes

Supporting References: HIPAA Privacy Rule Standard 164:508

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  4-13-2003  Board    4-13-2003
Related Document Code Related Document Name Type
1.MEM.24 Authorization for Disclosure of Protected Health Information Miscellaneous
1.MEP.19 Written Authorizations for Use and Disclosure of PHI Procedure

Policy:  Except as otherwise indicated in Community Care Policy and Procedure, Community Care may not use or disclose protected health information without a valid authorization. Community Care may not condition the provision to an individual of treatment or payment on the provisions of an authorization. All authorizations must be written in plain language and a signed copy provided to the individual. Individuals may revoke an authorization at any time. The revocation can be verbal or in writing and may exclude information that the entity has already taken action on. All authorizations must be kept as part of the client chart for a minimum of six years. Valid Authorizations must contain at least the following elements: a description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion; the name of the person or specific identification of the designee authorized to make the requested use or disclosure; the name or other specific identification of the person(s) to whom the covered entity may make the requested use or disclosure; a description of each purpose of the requested use or disclosure. (The statement “at the request of the individual” is a sufficient description of the purpose when an individual initiates the authorization and does not, or elects not to, provide a statement of the purpose); an effective date and expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure; signature of the individual and date (If the authorization is signed by a personal representative of the individual, a description of such representative’s authority to act for the individual must also be provided). In addition, the authorization must contain statements adequate to place the individual on notice of all of the following: The individual’s right to revoke the authorization verbally or in writing; the ability or inability to condition treatment or payment on the authorization; the potential for information disclosed pursuant to the authorization to be subject to re-disclosure by the recipient and will no longer be protected by Community Care Policy and Procedure. Community Care may include other information/elements as part of the authorization only to the extent that it is not inconsistent with the Policy outline above.