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VENDOR WRITTEN AUTHORIZATION FORM State of Oregon
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People also ask
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Which of the following are required on an authorization form?
The name (or other specific identification) of the person or class of persons authorized to make the requested use or disclosure. The name(s) or other specific identification of the person or class of persons to whom information will be disclosed. A description of the purpose of the requested use or disclosure.
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What is included in an authorization form?
A description of the specific information to be used or disclosed. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
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What must a written authorization form include?
The name (or other specific identification) of the person or class of persons authorized to make the requested use or disclosure. The name(s) or other specific identification of the person or class of persons to whom information will be disclosed. A description of the purpose of the requested use or disclosure.
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What are the core elements of a written authorization form?
Authorization Core Elements: The name(s) or specific identification of the person(s) or class of person(s) who will make the disclosure. The name(s) or specific identification of the person(s) or class of person(s) who will use the PHI or to whom the covered entity will make the disclosure.
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What does a valid authorization must contain?
The Department adopts in paragraph (c)(1), the following core elements for a valid authorization: (1) a description of the information to be used or disclosed, (2) the identification of the persons or class of persons authorized to make the use or disclosure of the protected health information, (3) the identification ...
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What is included in an authorization form?
A description of the specific information to be used or disclosed. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
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