Common use of Authorization for Release of Protected Health Information Clause in Contracts

Authorization for Release of Protected Health Information. A Health Insurance Portability and Accountability Act compliant authorization signed by the client or client’s legal representative, authorizing DBH to release the client’s information to a designated recipient. This form must be completed thoroughly with specified records to be shared, a designated time frame and expiration date, as well as a signature by the DBH client or his/her legal representative. If the form is signed by a legal representative, proof from the court system designating legal representation must accompany the request.