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Release of Protected Health Information Policy and Procedures

POLICY:

Great River Pediatric Clinic undertakes a legal and ethical responsibility to foster and preserve the privacy of patient protected health information in all its stages of development and use. The release of information within the patient medical record (chart), in most cases, requires prior authorization by the patient or their legally qualified representative before information is released, disclosed, or made available for review. There are exceptions to this patient right, which are identified elsewhere in this document and in Great River Pediatric Clinic’s Notice of Privacy Practices.

Standards for release of Information:
  1. A valid authorization must be received from the patient or their legally qualified representative.
  2. The authorization must be sent to Medical Records and the requested information can only be released from Medical Records.
  3. Great River Pediatric Clinic has 30 days to process the request, however, our goal is to process all requests within 10 days of receipt in Medical Records. Stat requests are processed ASAP.
  4. All other requests for information will be assessed a reasonable fee based on guidelines established by the state of AR.
  5. All subpoenas (state and federal) require written patient authorization before information can be released.
  6. Patients may revoke an authorization in writing. Great River Pediatric Clinic will honor this request as long as we have not already taken action on the previous authorization.
Definition of Valid Authorization

When complying with a patient request for a release of information, we must ascertain that the information released matches the information requested on the Patient Authorization Form (Attachment A) signed by the patient or legally qualified representative. Therefore, it is important that the patient understands that by completing the authorization, signing and dating it, they are authorizing the release of information about themselves. Although this form is primarily used in Medical Records, it should be completed anytime information is released regarding a patient’s medical treatment. We also honor “valid” patient authorization forms that are not Great River Pediatric Clinic’s Patient Authorization Form. To be valid a patient authorization must:

  1. Be in plain language.
  2. Be dated.
  3. Contain specific identification of the persons/agencies authorized to make the disclosure.
  4. Contain a specific description as to the nature of the information he/she is authorizing to be disclosed.
  5. Contain specific identification of the persons/agencies to whom he or she is authorizing information to be disclosed.
  6. Contain a specific description of the purpose for which the information may be used by any of the parties named above, both at the time of disclosure and at any time in the future.
  7. Be specific as to its expiration date, which must be within a reasonable period of time. If no date is supplied it will expire in 90 days.
  8. Be signed by the patient or his/her legally qualified representative
    • In the event the patient is unable to sign the authorization by reason of physical or mental disability, the authorization should be signed by the next of kin or legally appointed guardian. If possible, verification of such disability should be obtained in writing from a physician.
    • If the patient has died, the identified next of kin must sign the authorization unless an administrator or executor of the decedent’s estate has been appointed. If there is an administrator or executor of the decedent’s estate, that person must sign the authorization.
  9. State that the individual may revoke the authorization in writing and how they can do this.
  10. State that treatment, payment, enrolment, or eligibility for benefits may not be conditioned on obtaining the authorization.