20 19 CHECKLIST FOR VALID AUTHORIZATION

JurisdictionArkansas
LibraryArkansas Form Book - Complete (2023 Ed.)

20-19 CHECKLIST FOR VALID AUTHORIZATION

CHECKLIST FOR VALID AUTHORIZATION

1. Core elements:

? A specific description of the information to be used or disclosed.

? The person(s) or class of persons authorized to use or disclose the information.

? The person(s) or class of persons authorized to receive the information.

? A specific description of each purpose of the requested use or disclosure, unless the patient is initiating the authorization, in which case the patient may decline to offer a purpose and the...

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