Question

Assess the following authorization form against the Privacy Rule criteria and determine if any element (s) is /are missing. Modify the document by adding language to incorporate any element (s) found missing

Pine valley Community Hospital

AUTHORIZATION TO RELEASE HEALTH INFORMATION

Patient's Name: Julie Thomas__12/06/1986- Date of Birth:

___899441328_Patient's Social Security Number:

_______________________________________________ I hereby

authorize Pine Valley Medical Center to release to the following:

Name: _____________________________________________________________________

Address: ___________________________________________________________________

Documents to be released are: __________________________________________________

From Date of Service: _________________________________________________________

Purpose for record request is: ___________________________________________________

I understand that applicable laws may prohibit redisclosure of this information, but that PVMC

will not be liable or responsible for any redisclosure that takes place after the information has

been released.

I understand that I will not be denied treatment if I refuse to sign this authorization.

I understand that I am entitled to a copy of this authorization.

I understand that the information will be handled confidentially in compliance with applicable

state and federal laws.

I have read and understand the nature of this release.

________________________________________________ _________________________

Patient's Signature/Legal Representative Date

________________________________________________ _________________________

Witness Date

Answer 1

The authorization form to release health information lacks crucial elements required by HIPAA, including an expiration date for authorization, details of the right to revoke authorization, a statement about the risk of unauthorized re-disclosure, a more detailed description of information being disclosed, and consideration of sensitive health records disclosure. Language should be added to address these deficiencies and ensure the form's compliance with Privacy Rule criteria.

Step-by-step explanation:

Assessing the provided authorization form against the Privacy Rule criteria, there are several elements that appear to be missing. Firstly, the form lacks an expiration date for the authorization, which is a requirement under HIPAA. The authorization form should clearly state when the permission to release information expires. Additionally, the document should explicitly advise the patient of their right to revoke the authorization in writing at any time except to the extent that action has already been taken based on the authorization.

Another missing element is a statement regarding the potential for the information to be disclosed to unauthorized third parties once it has been released. Although the current form mentions that Pine Valley Medical Center (PVMC) is not responsible for redisclosures, it does not detail the risk that the information could be disclosed beyond the intended recipient. Furthermore, the specific information to be disclosed should be described in more detail to ensure that only the necessary health records are released, as required by the minimum necessary standard of the Privacy Rule.

Last but not least, the record release form fails to mention whether the authorization includes the disclosure of information regarding mental health records, substance abuse treatment, HIV/AIDS testing or results, or genetics testing, which are considered sensitive and generally subject to stricter protection and additional consent requirements.

To modify the document, language should be added to incorporate these missing elements and fully comply with HIPAA regulations. Ensuring completeness and legal soundness of the authorization form is imperative to protect patient privacy, abide by federal requirements, and maintain trust between patients and healthcare facilities.