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AUTHORIZATION FOR RELEASE OF INFORMATIONI hereby authorize all medical service resources and healthcare providers to use and/or disclose the protected health information (PHI) described
AUTHORIZATION FOR RELEASE OF INFORMATIONI hereby authorize all medical service resources and healthcare providers to use and/or disclose the protected health information (PHI) described below to: ABC Insurance Co.I hereby authorize the release of PHI covering the period of 10/20-24/2016.I hereby authorize the release of PHI as follows: entire health record.This authorization shall be in force and effect until nine (9) months after my death or June 1, 2017 (date or event) at which time this authorization expires.The purpose of this authorization is: personal use.I understand that I have the right to revoke this authorization in writing at any time. I understand that a revocation is not effective to the extent that any person or entity has already acted in reliance on my authorization or if my authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim.I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditional on whether I sign this authorization.I understand that information used or disclosed pursuant to this authorization may be disclosed by the recipient and may no longer be protected by federal or state law. Emma Carter Signed FIGURE 2-3 Authorization for Release of Information Sample 2 Please explain answer and cite also thanks the subject is case studies for health information management 3rd edition HIM Medical Receptionist alt [sendInfo] ok P: Patientinfo D: Mentcare-DB AS: Authorization login ( ) updateInfo() updatePRS (UID ) | authorize (TF, UID) authorization Message (OK) update (PID) update OK [sendSummary] UpdateSummary() summarize (UID) authorize (TF, UID) authorization Message (OK) PRS OK :summary update (PID) update OK logout (
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