Exercise 58 HIPAA Authorization Checklist CIOX e-SmartLog will be sunset from AHIMA VLab on June 1, 2020. Instructions: • Read the article in Appendix B – Practice Brief Authorization Requirements for the Disclosure of Protected Health Information (2013). • From your knowledge of HIPAA authorization requirements, or using the checklist below, determine whether a standard correspondence letter is available in CIOX to respond to requests lacking each requirement. • Create a new request entering basic data or open a previously entered request. • Click on the ‘New Correspondence Letter’ button in the bottom right corner to open the list of Standard e-Smartlog Correspondence Letters. • Indicate with a checkmark below whether a standard correspondence letter exists for instances when required information for a valid authorization is missing. Indicate the name of the correspondence letter where this information is found. Specific and meaningful description of PHI to be disclosed – Description of Disclosure Record contains sensitive information – Authorization Sensitive Information _ Name or specific identification of person authorized to disclose the information – there is only a letter specifying name of person authorized to make use of the disclosed information. Name of the person to whom the covered entity may make the disclosure – Name of Person Authorized to Make Use of Disclosure, also Unauthorized HIPAA with Reason Purpose of the requested use or disclosure – Unauthorized HIPAA with Reason Expiration date or event – Expiration Date Signature of the individual and date – Authorization Signature (Date) Authority of representative if not signed by patient – Unauthorized HIPAA with Reason Statement of patient’s right to revoke the authorization – Right to Revoke, also Unauthorized HIPAA with Reason Statement that information used may be subject to redisclosure by the recipient – Redisclosure by Recipient, also Unauthorized HIPAA with Reason
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