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CMS offers preview of authorization form

HIPAA Weekly Advisor, January 5, 2004

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2. CMS offers preview of authorization form

A new program memorandum from CMS lays out the necessary elements that must appear in any HIPAA-compliant authorization form. Fiscal intermediaries and carriers can craft their own authorization forms, but to comply with HIPAA privacy standards, those forms must contain at least the following elements, the agency said:

The core elements of a valid authorization must contain at least the following elements:

1. A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion

2. The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure

3. The name or other specific identification of the person(s) or class of persons, to whom the covered entity may make the requested use or disclosure

4. A description of each purpose of the requested use or disclosure

5. An expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure

6. The signature of the individual and date

In the program memo, CMS said it would make the final version of its standard authorization form available in several months. You can download the memo by clicking on the following link:

http://www.cms.gov/manuals/pm_trans/AB03147.pdf

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