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The \Tritten Author ization-

A uthori zati on Form h is imporranl to ascert.in whether or not statc law specifiesthe conrentof ar andDrizarion form for narriase and farnily therapisrsor other mental heahh profesionrls. If so, therapists should abide by the requirernentsof state law that are rppl i cabl eto thei r l i ce nsur e. U nder tl l l ' A A , " covered prov ider s" must use rudrorizitior fonns that contain specifiedcore clemcnts ind stxre nrentsrnd nry need or desirc to coln' hi ne such requi red cortent wit h provisionsfourd in rpplic.tble sratellv. IIIP A A resul N ti onsdo nor prohibit rLrrhorizition fonns from conu inins elcme ts or i nfortndti oni n rddi ri on t o ir s requi rements, provi dedthat suchadditi onsnre not i nconsi stent w i th the conrrnrs (lcscribc(ibebw l r i s Lrscful torcvi cwthe H IP AA r csul nti on rhnt spcci fi cs,for " co ver cr l providcrs," thc corc clen€nts 0nd statc-

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r1'Closer A Look r-uuK .,russr , J ltili$ii,t'#i,,i$ MrrriaFe and f.rmily drerrpisis seneral ly do nor rcleaseprricnt recordsor orher private health informltion colccrning parienrswnhour drc writtcn lDcl silancd authorizrrion of the p.tient. Two coD mon exceptioncto this generairule lrc fo u n di n nr andar or fyepo rti n gh w s (e .9 ., chiltl abuse, eldef ibuse, depende.t/ imprired eiluh abusc) rnd drngerous prtient statutcsorcasclar' l"'lhrasoff'1. i suchsituatiors, rher.rpistsarc allowcd or rcquired t.r rake acrion, witbour rhe p.rienfs wr irten ruthon2.]tion, whercin confidenri.rl,rymav lawf,rlly be brokcn. O rn l ru r hor iz ut ions r o f e l e rs ec o i d c n tin I parie.t i'r fo.marion arc gcncrallynor recognired rs appropridte and usually consnruie :'criorrhle bredchesof confr d e n ri i 1 ll. ' l he f oc usof th l s !rri c l e w i l l be on disclosurc of confidenrial intor' pursuanrro rhe prtien!'s writlen 'uriotr

a D ds i g n e d .u thori zrti on. Thcrapistsmusr be carefulwhen ihey consrrLtc(hcir own aurhoriT.rion fornr. They rnust be surc that the form cor plies with applicable state law or reguladon (and,if r "coveredprovider," wnh HIPA,A regulationr). Therapists must also bc carefDlwhen they releaseconfi deniiaLnrfornr.tion pursuart to r thifd pNrryls rurhorizatun fornt, which is signedbythe paticnt and allowsthcthcrapist to release nrformatnrn to the rcqucsrlngrhird p.rry. A failure to care fully recd the content of the fonn could lead io difficuhies for thc unrvary thcrapist. Note rhrt throughour the arliclc I refer to the fonn as an "authorizaiion," and not as a "release" or "waivcr" or "consentto rclease.'somc siale laws of regulrtions rnry refer to the frrm as soncthing orher rhan an "ruthorizrriotr" fonn. lf so, prrctitio.ers should

tion of rhe irrlornrationto bc usedordis clored thar idenrifiesthe inforrnattrn rr ,r specificand nrean ingfLrlfishion, 2 ) drc nrme or orherspeci fi ci denti fi cr r ionof thc pc!Rn(t, or classcs of pcrsons, autborizedm make thc rcquesteclusc or disclosure,3) the nrme or odrer specific identification of the perso(9, or dass of persorrs,to whom the coveredhealth cafe providef may mrke tbe requested useor disclosure,4 ) . descriptionofeach purpose of tlre use .rr disclosure,-5)an cxpiration darc or cxpifation event (somestatelaws only allow for a spccific datc) that rclatcs to thc n ividual or rhe purposeof rhe useor tUsclosufe,and 6)the nrdivrlual's signatureand date. ln rddition to dresecore ele ents, r valid authorization form (under Hll'AA regularioDs) nlust conrnin stateftent! adequatcto placerhett1iiividual(p.tient) on noticc of all of thc follorving: l) a sraremenrthar th€ in.lividual may revokc

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the aurho.izarion in !vriiing, and either F o rm s C oh3tructed by A) the exceptionstu th. ,ight to revokc O th e rs -Be C areful (e.9., when the therapist lras aheadr Supposcthat a p.ticlt tells you that he trken act;on in rclianceon tbe authori is seekirg a securityclearancefrom the zation or when the arthorization was U.S. Dcpartment of Defense.IIis desire obtained as a corditid of obrainins is to cooperarc wirh rhe Department irsurance coveragefor tlre paticnt and bccansehc w.11tsrhis p.fticularjob. He othcr hrv provides the inurer with the IeLlsyouthar r governnrenrinvestigatof ight ro contesta chin under the policy w i l l b e c o mi ng to seeyou and thrt he or the poLicyitself) a.d . descriptionof has already sisned an authodzation how rhe trrdividual rnay revoke the form allowingyou to shareinfornration !utho.;z.tioni or B) to the extent thrr w i rh th e D eparnnenrA rthi s poi nr,you thc urformrrion in "A" is includedin the should be rvary.h is not uncommon for MIT\ Noiice of I'rivicy Practices,r ref th e ra p i s i sto get caughtby surpri scbv erenceto such Noticc, 2) rhe potcrltirl suclr investigato|s .nd to liter be for infonnitiondisclosed pursu.ntkr thc :iccusedby thr prticnt of hreaking con.u th o r iz t r r iont o be s u b j e c to t re -d i s c l o ' fi d e n ti a l i ty-especi al l yi f the rccLrri ty su re by r he r ec ipie n ta n d ro l o n g e f c l e i r.n c edoesi oroccur. Y oushoul (l do protectedby t{lIANs "l\ivrcy Rule," 3) your bestto c.trefullyreview the author i st.tement dr.t dle MIiT m.ty nor izrriort fonn before berrg visited by rhc co d i t ionr r er r m enr o n th e p d ti e n t\s i g n -i n v e s ri g a i or.l erhrps th€ i nvesti gn r i n g o { t r n nudr o z ti o n (th e re a re cun fnx the fornr to yoLrthe ilay fufurc linitcd exceftiors to dris gcncral fLrle, h e r v i s i t s o drnt yoo can tnkc your ri me in revjcwing thc form. Or, pc.h.ts rhe It shoul< bc l not ed th n t n o l c o f th c prtjcnr has n copy of tbc f<xnr for you requircci clcnrcntsor sratcnrcntsspcci' fi e d .rbov cr dv is cr be p e rs o ns i s n i D sd re Upon revicq you nray cletenni e that a uthoriz:rti(n1 of hisor hcr righr r()rcccivc thc .rrrborization forn sigred by the a copy ofdrc siguctl:ruthr)riz:ui(lrrfornr. paticnt &)csrl't nalnc a particlrlartrrctiSu chr pr c v r s ions ho u l db e i n c l ' ,d e di n lioncf, but rrthcr, audmrizesilny "docrn ,ru d lor iT r t ion f ur m , rn d s o m es ta te nx" who trertcd fie pltient to rele|se l rws m . y wellr equir es L ,c ha p ro v rs i o n , "Nny and all medicalinfornrtion" to the perhrps more.Two iddiriotl,ll iremsthrr invesrigator.Are you consideredto be . should or must (dependinglrpol state " doctor?" \flill you be releasing" nedic.rl l i w) be inc ludedin s u c h fo rm s rre a n y informlrion?" Mighr the patienr hrcr l i mi ri t ionsr h. t m . y e x i s ra s ro rb c ty p e argue !hr! the authorization was not of informarion to bc used or disclosed applicablero a marriageand fanily ther.nd uy limirariims on rbc usc of drc apist,but was intenclcdro apply to thysi. i .fo rn r at ior rby t he p e n o n o r e n ti ti e s cians?Mighr the patie'rt hter N|gueth.t your recordswere nor prope.l) consid' aufho.ized to .eceivethe inform.]tioD. Those who rre nor IIll'AA "covered eredto be medicalrecordsrnd thxr state providers" would rypically abide by the liw mrkes a distinctionbet\reennedical law or regularionrbat spccifiescontentin recordsand menial health records? Iheir parricularsrarc.Stalelaw orregulaA thempist who determinesrhar an Inr mayalloiv.rsI lPAA does,additional authorizationis vasueor arnbiguouscan elemenrsor statementsto be includedin have the patient sign enother authoriza dreruthorization form as lons ar they do rxrn. The therepisrcan then be referred doi co.{lict with rhe staterequred con ro \ nane and licersure,rnd the records rent.In rheevenrrhata therapist(norgov- can be refcrrcdto wuh more parricDlari ernedby HIPA-A)u in a jurisdictionwhere ry than 'lnedical records." h addrtion, rbe conrenrof dre ruthorization form is rhe thcrapist nighr w.nt to look at rhe not rnrndated, but lelt to rhe discretion authorizatioD fon for other pos;ble of the tractitioner, the prrctit;oner nay problems or linitariom. For hsrAnce, !van! to consider includnrg rhe content sone aurhorizarionsmay be for records dercribedn this anicle. onll', while othersmay be nrorecompre

hensiveand m.y allov the thcrapist to talk with thc ilvcstigator, enswer ques rions, and rcvcal informat;on that may not be cortained in ihe .ecords.

Lnother techricality to be alert to nvolvcs the issue of revocation of an authorizaridl. Many state lrws thit addrcssthis issuerequire the revocation to bchwriinrg. Oral rev.rc.ltionsare usu allv not coDsideredro be vrlid or effec tiYe. A p3ticnrt wr;tre. and signed aurhorizarionnray senerallybc revokcil a!.rnytime, providedthar thc revc3 ti(ri is in writingand cxccprtu tlreexteDttlrat the thcripht n3y hive taken action in reli:rnceon th€ p.rient's writren authori z:rrion.Therapistsmust thereforecrrefully m:rD.rgesirurtions where r parient calls ro inforn rhe rherapist rhar he or shc no longerwrn!s his or her recordsto It released,cventhough the p:rricnth;rs alreadysignctlan aLrthoriz.rrion. The therlpist should inform rlic p ti€nt rhat rcvocationsn1ustl)c in writing (unlessofal revocatioN arc pcrnissiblein a pr fticular srite) and should foll ow throughw i rhtheptrri €nrto m akcslue thrt the wri(cn rcvocation is produced forthwith. lf a thcrapisrwere r(r bc ncg' lectfrl in this rcgard,the thefapistmight encounterproblcms.!'or iDsrarre,acting upon thc oral rcvocatior may fesul! in ihe deniil of a bcncfltto rh€prrienr, who may later :rssertthrt he grve lhe ther.pisr no oral insrrocrionsregardingrcvoc,ltionand thar rherherrpisrsimplyfailed to conply withrhe s'rirtenaurluizrrnnr. The patientmay also arguerhar the ther apisrshould havc knowl rhat oralrevo cationsiv€re nor valid. Slgnature Therapisisshould not releaseconf crlial infofnarion about a pirieDr wirhout an appropriate signarurefrom thc pcrson o. personswhose signaft,rels)nav be required. llnder HIPAA regulations, if an rDthorization ro discloseinforma t;o. is signedhy a personalrepresenta i;ve of the patient,r descriptionof such representative's ruthofiiy ro acr for d1e prtient must be included in dre form. Generalu either parent may sisn an

iuthoizadon for a minor child as thc (it is sood personalrepresentative chiL
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