Authorization for Disclosure of Health Information definition

Authorization for Disclosure of Health Information means the executed release authorizing the disclosure of protected health information in accordance with Labor and Employment Article, §§9-709, 9-710, and 9-711, Annotated Code of Maryland.
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Examples of Authorization for Disclosure of Health Information in a sentence

  • The AGENCY shall use and promote the use of a standard, community-wide Patient Authorization for Disclosure of Health Information - Multiparty Release of Information Form, upon request.

  • Please make sure to send in your Authorization for Disclosure of Health Information form* Date: Company: Marquette UniversityFirst Name: Last Name: 9 Digit Employee ID: Date of Birth: Home Phone: ( ) (Not SSN#) Marquette Employee Spouse of a Marquette Employee Email: An email notification will be sent to patient once Aurora Wellness Services receives this completed form.

  • Revocation of Authorization for Disclosure of Health Information form is available from our Corporate Compliance Officer.

  • The Authorization for Disclosure of Health Information form is valid for 90 days from the date of signature, unless provided otherwise by you.

  • Health Evaluation ChecklistThe following forms must be completed and uploaded to CastleBranch by August 24: Acknowledgement of Receipt of Notice of Privacy PracticesMercy Medical Center – General Authorization for Disclosure of Health Information WITCC Clinical Health Evaluation – health history, physical, and immunizations Hepatitis B Vaccine Consent or Decline to Accept FormCriminal Background - General Information Pre ClinicalWITCC will complete criminal background checks on all health students.

  • If you would like to revoke your authorization, you must request revocation in writing or fill out a Revocation of Authorization for Disclosure of Health Information form.

  • The content of all therapy sessions and the information you disclose is considered confidential and will generally not be released by IBC without an Authorization for Disclosure of Health Information form.

  • Signature of patient or patient representative Date Authorization for Disclosure of Health Information I hereby authorize Orthopedic Center of Florida to release/discuss my Protected Health Information to include but not limited to billing, treatment, test results etc., with the following individuals: __ _ _ __ NAME DOB RELATIONSHIP __ _ _ __ NAME DOB RELATIONSHIP __ _ _ __ NAME DOB RELATIONSHIP This authorization will remain in effect until such time as I submit a change in writing.

  • Enclosed was an MDOC Patient’s Authorization for Disclosure of Health Information which sought “[a]ny and all medical records and institutional file, including electronic records and grievances[.]” Doc.

Related to Authorization for Disclosure of Health Information

  • Health information means any information or data except age or gender, whether oral or recorded in any form or medium, created by or derived from a health care provider or the consumer that relates to:

  • Summary Health Information means information (a) that summarizes the claims history, claims expenses, or type of claims experienced by individuals for whom a plan sponsor had provided health benefits under a health plan; and (b) from which the information described at 42 CFR Section 164.514(b)(2)(i) has been deleted, except that the geographic information described in 42 CFR Section 164.514(b)(2)(i)(B) need only be aggregated to the level of a five-digit ZIP code.

  • Protected Health Information or “PHI” shall have the same meaning as the term “protected health information” in 45 C.F.R. § 160.103, and includes electronic PHI, as defined in 45 C.F.R. 160.103, limited to information created, maintained, transmitted or received by the Business Associate from or on behalf of the Covered Entity or from another Business Associate of the Covered Entity.

  • Protected Health Information (PHI) means individually identifiable health information created, received, maintained or transmitted by Business Associate on behalf of a health care component of the Covered Entity that relates to the provision of health care to an Individual; the past, present, or future physical or mental health or condition of an Individual; or the past, present, or future payment for provision of health care to an Individual. 45 CFR 160.103. PHI includes demographic information that identifies the Individual or about which there is reasonable basis to believe can be used to identify the Individual. 45 CFR 160.103. PHI is information transmitted or held in any form or medium and includes EPHI. 45 CFR 160.103. PHI does not include education records covered by the Family Educational Rights and Privacy Act, as amended, 20 USCA 1232g(a)(4)(B)(iv) or employment records held by a Covered Entity in its role as employer.

  • personal health information means, with respect to an individual, whether living or deceased:

  • Health information exchange or “HIE” shall mean the Common HIE Resources and infrastructure made available to Participants by CRISP for Permitted Purposes, as defined in Section 3.02 of the Terms and Conditions, subject to the terms of the Agreement. Common HIE Resources shall not include the technological infrastructure provided by the Direct Technology Provider for the Direct Service.

  • Electronic Protected Health Information (EPHI) means Protected Health Information that is transmitted by electronic media or maintained in any medium described in the definition of electronic media at 45 CFR 160.103.

  • Protected Health Information or PHI means any information, whether oral or recorded in any form or medium: (i) that relates to the past, present or future physical or mental condition of an individual; the provision of health care to an individual; and (ii) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501. Protected Health Information includes Electronic Protected Health Information [45 C.F.R. Sections 160.103, 164.501].

  • Electronic Protected Health Information means Protected Health Information that is maintained in or transmitted by electronic media.

  • Business Confidential Information has the meaning set forth in Section 5.04(a).

  • Appendix Information means the information which must be provided for the selected modules as set out in the Appendix of the Approved EU SCCs (other than the Parties), and which for this Addendum is set out in:

  • Authority's Confidential Information means all Personal Data and any information, however it is conveyed, that relates to the business, affairs, developments, trade secrets, know-how, personnel, and suppliers of the Authority, including all IPRs, together with all information derived from any of the above, and any other information clearly designated as being confidential (whether or not it is marked "confidential") or which ought reasonably be considered to be confidential;

  • Customer Information means any information contained on a customer’s application or other form and all nonpublic personal information about a customer that a Party receives from the other Party. Customer Information shall include, but not be limited to, name, address, telephone number, social security number, health information, and personal financial information (which may include a Masterworks user account number).

  • Program Information has the meaning set forth in Section 14.8.

  • Other Confidential Consumer Information The Contractor agrees to comply with the requirements of AHS Rule No. 08-048 concerning access to information. The Contractor agrees to comply with any applicable Vermont State Statute, including but not limited to 12 VSA §1612 and any applicable Board of Health confidentiality regulations. The Contractor shall ensure that all of its employees and subcontractors performing services under this agreement understand the sensitive nature of the information that they may have access to and sign an affirmation of understanding regarding the information’s confidential and non- public nature.

  • Citizens Confidential Information means all information, data, and documentation, whether marked as confidential or not, disclosed to Vendor in the course of this Agreement that is either: (a) Protected under any applicable state or federal law (including Chapter 119, Florida Statutes; Sections 501.171, and 627.351(6), Florida Statutes; Chapter 69O-128, Florida Administrative Code; and, 15 U.S.C. § 6801 et seq.); (b) private information concerning Citizens’ employees or policyholders (including social security numbers, personal health information, personal credit information, banking information, drivers’ license numbers, personal email addresses, personal phone numbers, and home addresses); or, (c) related to any Citizens’ manuals, lists, operating and other systems or programs, business practices or procedures, insurance policies, claimants or claims, or any business, governmental, and regulatory matters affecting Citizens. “Citizens Confidential Information” does not include any information, data or documentation that: (a) is publicly available through no fault of Vendor or Vendor Staff; or, (b) Vendor developed independently without relying in any way on Citizens Confidential Information.

  • Seller Confidential Information has the meaning set forth in Section 6.4.3.

  • Exempt Information means any information or class of information (including but not limited to any document, report, Agreement or other material containing information) relating to this Agreement or otherwise relating to the Provider, which potentially falls within an exemption to FOIA (as set out therein);

  • Unsecured Protected Health Information means protected health information that is not secured by a technology standard that renders protected health information unusable, unreadable, or indecipherable to unauthorized individuals and is developed or endorsed by a standards developing organization that is accredited by the American National Standards Institute.

  • Trade Secret Information means all information, regardless of the form or medium in which it is or was created, stored, reflected or preserved, that is not commonly known by or generally available to the public and that: (i) derives or creates economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; and (ii) is the subject of efforts that are reasonable under the circumstances to maintain its secrecy. The Company’s Trade Secret Information may include, but is not limited to, all confidential information relating to or reflecting the Company’s research and development plans and activities; compilations of data; product plans; sales, marketing and business plans and strategies; pricing, price lists, pricing methodologies and profit margins; current and planned incentive, recognition and rewards programs and services; personnel; inventions, concepts, ideas, designs and formulae; current, past and prospective customer lists; current, past and anticipated customer needs, preferences and requirements; market studies; computer software and programs (including object code and source code); and computer and database technologies, systems, structures and architectures. You understand that Confidential Information and/or Trade Secret Information may or may not be labeled as such, and you shall treat all information that appears to be Confidential Information and/or Trade Secret Information as confidential unless otherwise informed or authorized by the Company. Nothing in this Agreement shall be construed to mean that Company owns any intellectual property or ideas that were conceived by you before you commenced employment with Company and which you have previously disclosed to the Company. Subject to Section 4.3(b), nothing in this Section 4.3(a) shall prevent you from complying with a valid legal requirement (whether by oral questions, interrogatories, requests for information or documents, subpoena, civil investigative demand or similar process) to disclose any Confidential Information or Trade Secret Information.

  • Customer Confidential Information means Confidential Information of the Customer provided to Computershare.

  • Supplier's Confidential Information means any information, however it is conveyed, that relates to the business, affairs, developments, trade secrets, Know-How, personnel and suppliers of the Supplier, including IPRs, together with information derived from the above, and any other information clearly designated as being confidential (whether or not it is marked as "confidential") or which ought reasonably to be considered to be confidential;

  • Customer's Confidential Information means all Personal Data and any information, however it is conveyed, that relates to the business, affairs, developments, trade secrets, know-how, personnel, and suppliers of the Customer, including all IPRs, together with all information derived from any of the above, and any other information clearly designated as being confidential (whether or not it is marked "confidential") or which ought reasonably be considered to be confidential;

  • Individually Identifiable Health Information means information that is a subset of health information, including demographic information collected from an individual, and: (a) is created or received by a health care provider, health plan, employer, or health care clearinghouse; (b) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and (c) that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

  • Patient Information means information (however recorded) which—

  • information folder means the complete folder, including the information document, file, data, drawings, photographs, and so on, supplied by the applicant, it being permissible to supply the information folder in the form of an electronic file;