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Sample Consent Agreement

Author: AHIMA Staff

Source: AHIMA sample form

Publication Date: May 02, 2001




Consent to the Use and Disclosure of Health Information for Treatment, Payment, or Healthcare Operations


I understand that as part of my healthcare, this organization originates and maintains health records describing my health history, symptoms, examination and test....

Sample Policy: Protecting Patient Privacy from Outside Callers

Author: AHIMA

Source: Journal of AHIMA

Publication Date: February 2003


Background: It is customary for family members, legal guardians, and friends of patients at [name of hospital] to telephone the hospital, inquire in person about the condition of a patient, or to request other health information. Privacy regulations require that a patient’s identity or oth....

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