10A N.C. Admin. Code 23H .0110 - CONSENT FOR RELEASE
(a) As a part of
the application process for Medicaid, the client shall be informed of the need
for and give consent to release of information for verification of statements
to establish eligibility.
(b) No
individual shall release any client information that is owned by the Division
of Health Benefits or the county departments of social services, or request the
release of information regarding the client from other agencies or individuals,
without obtaining a signed consent for release of information. The procedure
for disclosure without obtaining consent shall be in accordance with Rule .0111
of this Section.
(c) The consent
for release of information shall contain the following:
(1) The name of the provider and the
recipient of the information;
(2)
The extent of information to be released;
(3) The name and dated signature of the
client;
(4) A statement that the
consent is subject to revocation at any time except to the extent that action
has been taken in reliance on the consent; and
(5) The length of time the consent is
valid.
(d) The client
may alter the form to contain other information, including:
(1) A statement specifying the date, event,
or condition upon which the consent may expire even if the client does not
expressly revoke the consent; or
(2) A specific purpose for the
release.
(e) The
following persons may consent to the release of information:
(1) The client;
(2) The legal guardian if the client has been
judged incompetent; or
(3) The
county department of social services if the client is a minor and in the
custody of the county department of social services.
(f) Prior to obtaining a consent for release
of information, the director or delegated representative shall explain the
meaning of informed consent. The client shall be told the following:
(1) Contents to be released;
(2) That the information is needed to verify
eligibility;
(3) That the client
can give or withhold the consent and the consent is voluntary; and
(4) That there are statutes, rules, and
regulations protecting the confidentiality of the information.
Notes
Eff. September 1, 1984;
Amended Eff. August 1, 1990;
Transferred from 10A NCAC 21A .0410 Eff. May 1, 2012.
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