Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: UPDATED VERSION OF THE MO 650-2616 (HIPAA) AUTHORIZATION FOR DISCLOSURE OF CONSUMER MEDICAL/HEALTH INFORMATION FORM POSTED
The purpose of this memorandum is to inform staff the most recently revised version of the MO 650-2616 (HIPAA – Authorization for Disclosure of Consumer Medical/Health Information) has been posted in the IM Forms Manual .
The MO 650-2616 was revised by the Department of Mental Health (DMH) to help streamline processes and produce better results with form completion and return by participants as well as improved accuracy and timeliness.
Staff must immediately begin using the MO 650-2616 dated (01/16), and discard the previous version of this form.
- Review this memorandum with appropriate staff.