AUTHORIZATION TO RELEASE INFORMATION

This permission form is intended to comply with the mandates of federal and state privacy laws regarding the disclosure of your protected health information. Your permission makes it possible for the Health Plan, which might be your health insurance company or HMO, to disclose your sensitive patient information to a specific individual or organization of your choosing. The release of information, also known as ROI, in the medical field is an extremely important factor in determining the level of continuity of care that a patient receives. It also plays an essential part in billing, reporting, research, and other duties. There are a number of laws and regulations that control the distribution of protected health information (PHI), including how, when, what, and to whom it can be given.

 The date and time when the request was received were also recorded. Specified the date and time by which the information that was sought was required. Specified the recipient of the information that was going to be sent. Verified that the request in question had a legitimate permission.