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Music the Ohio Department of Medicaid created a standard authorization form that individuals can use to approve the use and disclosure of their protected health information for pH I'm including information related to substance use disorders it is important to note that this form is not a patient right to access request the form was created by the Ohio Department of Medicaid to provide a standard way for any individual not just Medicaid recipients to request pH I be released across the state of Ohio there are two sides to the form an is for the release of pH I from covered entities under HIPAA several third parties might find this form useful including attorneys criminal justice organizations or court systems to request information on behalf of an individual HIPAA does not require approval to release pH I for the purposes of treatment payment or healthcare operations HIPAA also permits a covered healthcare provider to disclose pH I for the treatment of an individual to a third party such as a social service agency that is involved in the coordination or management of health care of that individual Form by is for the release of information from a substance use disorder program or provider unlike HIPPO substance use disorder information is not allowed to be shared for the purposes of treatment payment for health care operations without the written consent of the individual the form does not replace any existing release of information forms being used it is simply an additional option however if properly executed the form must be accepted by any person or entity within the state of Ohio a form will not be considered properly executed unless all required fields are completed these fields are marked with an asterisk or a star some other fields on the form are not marked as required but will help them to receive entity identify your records for example including a whole or partial social security number will allow the receiving entity to know exactly whose records to pull when completing the form please be very clear about what records or information are being requested asking for only what is needed and being very specific may speed up the processing of your request if you have any questions feel free to contact standard off forum at Medicaid Ohio gov
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