Ohio Admin. Code 5160-1-32.1 - Standard authorization form

(A) In accordance with section 3798.10 of the Revised Code, a standardized authorization form that meets all requirements specified in 45 C.F.R. 164.508 and, where applicable, 42 C.F.R Part 2 as in effect on October 1, 2018, for the use and disclosure of protected health information is found in appendix A to this rule.

(B) If the standardized authorization form is properly executed, and adequately identifies the individual identified in section I of the form found in appendix A to this rule, by either an individual or the individual's personal representative, it shall be accepted by any person or governmental entity in this state as valid authorization for the use or disclosure of the individual's protected health information to the persons or governmental entities specified in the form. Please use the instructions found in appendix B to this rule to assist with completing the standard authorization form.

(C) A person or governmental entity is not precluded from accepting as valid authorization for the use or disclosure of protected health information a form other than the form prescribed in paragraph (A) of this rule if the other form meets all requirements specified in 45 C.F.R. 164.508 and, if applicable, 42 C.F.R Part 2 as in effect on October 1, 2018.

(D) Nothing in this rule shall require obtaining authorization or use of the form found in appendix A to this rule when use or disclosure of the information is required or permitted without such authorization by 45 C.F.R. Chapter A, Subchapter C and, if applicable, 42 C.F.R. Part 2 as in effect on October 1, 2018.

(E) The standard authorization form must be accepted state-wide thirty days post effective date.

Appendix A

Appendix B

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Notes

Ohio Admin. Code 5160-1-32.1

Effective: 1/3/2019
Five Year Review (FYR) Dates: 01/03/2024
Promulgated Under: 119.03
Statutory Authority: 5162.02, 5164.02, 3798.10
Rule Amplifies: 3798.10