Consent for Uses or Disclosures

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5/11 EXAMPLES

Text in this Example:

Consent for Uses or Disclosures to
Carry Out Treatment,
Payment or Healthcare Operations
Ask the patient to read, sign, and date the consent form on the designated areas
Explain that the consent is needed prior to releasing healthcare information about the patient's treatment, payment for healthcare services or to support healthcare operations
Review the purpose of the consent with the patient
Determine if a consent is needed from a patient prior to proceed to disclose confidential healthcare information