HIPAA Authorization Template
The HIPAA Authorization Template and the information requested should be kept in each employee record. CMP105-1 HIPAA AUTHORIZATION FORM authorizes the use or disclosure of the employee’s protected health information as described on the form. Access to employee medical records should be limited to managerial personnel with a need to know about restrictions or accommodations concerning an employee’s duties and first aid personnel where an employee’s medical condition might require special treatment.
The Benefit Coordinator should create a record or log for each set of records—medical, psychotherapy, and personnel. Names of those who accessed each set or records should be available. The patient, or employee, also has the right to know who accessed the records, when, and for what reason. To protect patient privacy, employees must take extra precautions, both in structures and in circumstances, not to inadvertently release patient information. Patients may choose to deny the provider from using their information for a variety of reasons. Patients can opt out of any portion of the notice.
HIPAA Authorization Template Details
Format: Microsoft Word 2013 (.docx)
Manual: Human Resources
Procedure: Health Insurance Portability Accountability Procedure HIPAA CMP105
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