Ariz. Admin. Code § R20-6-1204 - Release of Confidential Hiv-related Information; Release Form

A. Except as required by law or authorized pursuant to a written consent to be tested, an insurer shall not disclose confidential HIV-related information to any person unless a written release form is executed by the applicant or, if the applicant lacks legal capacity to consent to such release, by a person authorized by law to consent to the release of information on behalf of the applicant. The applicant or the applicant's legal representative shall be entitled to receive a copy of the release. A photocopy shall be as valid as the original.

B. Such written release form shall contain the following information:

1. The name and address of the person to whom the information shall be disclosed;

2. The specific purpose for which disclosure is to be made; and

3. The time period during which the written release is to be effective but in no case shall such time period exceed 180 days from the date the release is signed by the applicant or the applicant's legal representative;

4. The signature of the applicant or of the person authorized by law to consent to such release, and the date the release form was signed.

Notes

Ariz. Admin. Code § R20-6-1204

Adopted effective March 7, 1994 (Supp. 94-1). R20-6-1204 recodified from R4-14-1204 (Supp. 95-1).