What are the required elements in an Authorization?

  • Specific and meaningful description of what information will be used or disclosed.
  • Identification of who may use or disclose the PHI.
  • Identification of to whom the PHI will be disclosed.
  • Why the use or disclosure is being made - each purpose must be included.
  • Statement regarding how long the use or disclosure will continue. For research purposes no expiration date is required but this must be stated in the authorization.
  • Notice that the authorization may be revoked by the subject.
  • Notice that the information may be disclosed to others who are not subject to the Privacy Rule.
  • Notice that the covered entity may or may not condition treatment or payment on the individual's signature of the authorization.
  • Individual's signature and date.

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