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Title:	Health Insurance Portability and Accountability Act (HIPAA) Act of 1996 Authorization Form (Form 2532/002)
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Handle:	Document-1308
Owner:	Laiche, Karen (User-23, klaich:DocuShare)^DS
Create Date:	Wednesday, November 17, 2004 01:53:00 PM CST
Modified Date:	Wednesday, November 17, 2004 01:53:44 PM CST
Modified By:	Laiche, Karen (User-23, klaich:DocuShare)^DS
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Abstract:	HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 AUTHORIZATION FORM FOR HEALTH INFORMATION TO BE DISCLOSED TO DELGADO COMMUNITY COLLEGE (“DELGADO”) The status of the person whose health information is authorized for disclosure (check one): o Student o Student-Applicant o Employee o Employee-Applicant Name (please print): ________________________________________________________________ (The name of the person about whom the health information relates) Address: ...
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Content Type:	Microsoft Office Word (.doc, .dot) - application/msword
File name:	2532-002.doc
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Max Versions:	4
Size:	37888
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Ready for Declare:	No
Appears In:	CLINICAL PRACTICUM FORMS
Preferred Version:	Health Insurance Portability and Accountability Act (HIPAA) Act of 1996 Authorization Form (Form 2532/002)