Authorization for Use and Disclosure of Protected Health InformationDue to changes in federal law, a revised release of information disclosure form must be used for all requests for personal health information.Please print the form by downloading it via the link to the right. Fill it out completely and take it to your physician clinic or our Medical Release of Information Office.The authorization for release of information is not valid, according to the privacy rule, if the authorization has any of the following defects:The expiration date or event has passedThe authorization has not been filled out completely with respect to the required content listed aboveThe authorization is known by the covered entity to have been revokedThe authorization is a prohibited type of compound authorization (must not be combined with any other document or request)Any material information in the authorization is known by the hospital to be falseBackground: The federal government published the standards for privacy of individually identified health information on December 28, 2000. These standards are also known as the HIPAA privacy rule. The rule establishes standards for information disclosure - including what constitutes a valid authorization. Below is an overview of this information for future reference. As of April 14, 2003, each hospital will need to comply with the new HIPAA rules. Health Information ExchangeMost people have had more than one provider, insurance plan or network in their lives. This means you might have medical records that are stored in two or more different systems. It's important for your provider to have your complete health care record. This helps them make the best decisions about your treatment and medications. Health Information Exchanges (HIE) make it possible for providers to access their patients' medical information from different locations securely. CoxHealth currently participates in a regional and national HIE. This allows your provider to access parts of your CoxHealth medical record even if they are not part of the CoxHealth system. These records include:Lab resultsPrescribed medicationsList of allergiesPast surgery recordsOther medical histories important to your careGetting medical records from one provider to another can be time-consuming, but HIEs are designed to make your medical care more convenient, accessible and safe. HIEs are secure and protected by the federal government. If you would like to opt-out of CoxHealth’s affiliated HIEs, please use this Request to Opt-Out Form. You may revoke your previous opt-out status in order to have your information shared on the HIE, using the Revocation of Opt-Out Request form. You have two options to return these forms:You can bring the form to your clinic or a hospital registration area to sign. A notary is not required.You can email a notarized form to HIM-ChartRelease@coxhealth.com.