Fla. Admin. Code Ann. R. 59B-16.002 - Universal Patient Authorization Forms
(1) The Universal Patient Authorization Form
for Full Disclosure of Health Information for Treatment and Quality of Care
including instructions for completing the form is posted at:
www.FHIN.net. The form may be printed,
completed, signed and scanned into an electronic format as provided in
subsection 59B-16.001(2),
F.A.C. The Universal Patient Authorization Form for Full Disclosure of Health
Information for Treatment and Quality of Care, Form Florida AHCA FC4200-004
7.1.2011 is incorporated by reference and the Spanish language version,
Formulario de Autoización Universal para Dar a Conocer
Información Médica Completa para Tratamiento & Calidad de
Cuidado, Form Florida AHCA FC4200-006 7.1.2011,
https://www.flrules.org/gateway/reference.asp?NO=Ref-01202,
is incorporated by reference.
(2)
The Universal Patient Authorization Form for Limited Disclosure of Health
Information including instructions for completing the form is posted at:
www.FHIN.net. The form may be printed,
completed, signed and scanned into an electronic format as provided in
subsection 59B-16.001(2),
F.A.C. The Universal Patient Authorization Form for Limited Disclosure of
Health Information, Form Florida AHCA FC4200-005 7.1.2011 is incorporated by
reference and the Spanish language version, Formulario de Autoización
Universal para Dar a Conocer Información Médica Completa para
Tratamiento & Calidad de Cuidado, Form Florida AHCA FC4200-006 7.1.2011,
https://www.flrules.org/gateway/reference.asp?NO=Ref-01202.
Notes
Rulemaking Authority 408.051(4)(b), 408.15(8) FS. Law Implemented 408.051(4) FS.
New 7-28-10, Amended 5-14-12.
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