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CMS describes HIPAA authorization form
The Centers for Medicare & Medicaid Services (CMS) offers a preview of a privacy authorization form that includes the core elements and necessary statements required in the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
CMS is developing a standard authorization form for Medicare beneficiaries to use to authorize CMS to release personal health information to a third party. Although the form will not be available for several months, the program memorandum offers a guide to the elements necessary for a valid privacy authorization. The core elements of a valid authorization must contain at least the following elements:
The memorandum also includes examples of wording that may be used to place an individual on notice that he or she can revoke the authorization and the process that must be followed to revoke authorization.