Authorization For The Use And Disclosure Of Confidential Information

An authorization for the use and disclosure of confidential information must be in writing, and identify the individua l who is the subject of the record. (3-17-22) 01. Content of Authorization. An authorization must be dated and signed by the individual or lega l representative, and: (3-17-22) a. Identify the specific information involved; (3-17-22) b. State the duration of the authorization, defined by a specific date or the description of an event; (3-17-22) c. Identify the recipient of the information; and (3-17-22) d. State the purpose for the authorization, or state that it is, “At the request of the individual,” or similar wording. (3-17-22) 02. Defective Authorization. An authorization must not be acted upon if the authorization has expire d or has been revoked, or if any essential information is omitted or is false. (3-17-22) 03. Authorization for the Use and Disclosure of Health Information. An authorization for the us e and disclosure of health information must contain the content listed in Subsection 051.01 and the statements require d by 45 CFR 164.508(c)(2). (3-17-22) 04. Psychotherapy Notes. Psychotherapy notes that are separate from the rest of an individual’s recor d may not be used or disclosed without an authorization except to the originator of the notes for treatment or to defen d the Department in a legal action brought by the individual. (3-17-22) 05. Revocation of an Authorization. An individual or legal representative may revoke a n authorization at any time by submitting a written request at any Department office. (3-17-22) 06. Effect on Benefits and Services. An individual’s refusal to provide an authorization does no t affect the receipt of benefits or services the individual would otherwise receive. (3-17-22) 07. Copy of Authorization. The Department will provide a copy of the signed authorization to th e individual or legal representative. (3-17-22) 052. -- 074. (RESERVED)