IM-136 10/17/03 HIPAA COMPLIANT DISCLOSURE OF HEALTH INFORMATION FORM
|HIPAA COMPLIANT DISCLOSURE OF HEALTH INFORMATION FORM|
|Effective immediately begin using Form
MO 650-2616 (01-03), Authorization for Disclosure of Consumer Medical/Health
Information, when requesting health information from medical providers
or other agencies. A copy of the form is attached to this memo.
The Authorization for Disclosure Form is available on the Intranet.
The IM-60 is being revised to use as a cover letter with the Authorization for Disclosure. A separate memo will be issued when the IM-60 is complete.
Electronic Form available at Forms Download Page