Card Pick Up Authorization Form Office of the Controller the Ohio

Instructions and help about Card Pick up Authorization Form Office Of The Controller The Ohio

[Music] the Ohio Department of Medicaid created a standard authorization form that individuals can use to approve the use and disclosure of their protected health information for ph i including information related to substance use disorders it is important to note that this form is not a patient right to access request the form was created by the Ohio Department of Medicaid to provide a standard way for any individual not just Medicaid recipients to request pH I be released across the state of Ohio there are two sides to the form form a is for the release of pH I from covered entities under HIPAA several third parties might find this form useful including attorneys criminal justice organizations or court systems to request information on behalf of an individual HIPAA does not require approval to release pH I for the purposes of treatment payment or healthcare operations HIPAA also permits a covered healthcare provider to disclose pH I for the treatment of an individual to a third part