Authorization for Release of Medical Information – Cal. Civ. Code § 56.11

“Authorization; form and contents”

A person or entity that wants medical information and is not authorized to receive it, must obtain a valid authorization for release of information.  To be valid, the authorization must be:

• Handwritten or typed by the same person who signs it for the purpose of executing the authorization 
• Signed and dated by the patient, the legal representative, spouse, beneficiary or personal representative of the patient (if deceased)
• States the specific uses and limitations of the types of medical information to be disclosed
• States the name of the provider of health care, health care service plan, pharmaceutical company, or contractor that may disclose the medical information
• States the name or functions of the persons or entities authorized to receive the medical information
• States the specific uses and limitations on the use of the medical information by the persons or entities authorized to receive the medical information
• States a specific date that the authorization expires when the provider, health care service plan, pharmaceutical company, or contractor is not authorized to disclose the medical information
• Advises person signing that they have a right to receive a copy of the authorization.

Tags:

Patients, Claims data, Clinical data, Individually identifiable data, Use, Exchange, Records retention and access to information, Notice and consumer protection, Privacy