NRPM: Standards for Privacy of Individually Identifiable Health Information. 3. Model forms.


Covered entities and third parties that wish to have information disclosed to them would need to prepare forms for individuals to use to authorize use or disclosure. A model authorization form is displayed in Appendix to this proposed rule. We considered presenting separate model forms for the two different types of authorizations (initiated by the individual and not initiated by the individual). However, this approach could be subject to misuse and be confusing to covered entities and individuals, who may be unclear as to which form is appropriate in specific situations. The model in the appendix accordingly is a unitary model, which includes all of the requirements for both types of authorization.