Form 99 Authorization for the Use / Disclosure of Protected Health Information - Mississippi

What Is Form 99?

This is a legal form that was released by the Mississippi Department of Health - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 99?
A: Form 99 is an Authorization for the Use/Disclosure of Protected Health Information.

Q: Who needs to complete Form 99?
A: Anyone who wants to authorize the use or disclosure of their protected health information.

Q: What is the purpose of Form 99?
A: The purpose of Form 99 is to provide consent for the use or disclosure of protected health information in Mississippi.

Q: What information is required on Form 99?
A: Form 99 requires the individual's name, contact information, medical provider information, and details of the authorized use or disclosure.

Q: Is Form 99 specific to Mississippi?
A: Yes, Form 99 is specific to Mississippi and may have variations in other states.

Q: What are the potential uses of the disclosed health information?
A: The potential uses of disclosed health information can include treatment, payment, healthcare operations, research, or specific purposes as authorized by the individual.

Q: How long is the authorization valid?
A: The duration of the authorization is specified on Form 99 and can vary depending on the individual's preference or circumstances.

Q: Can I revoke or cancel an authorization on Form 99?
A: Yes, individuals have the right to revoke or cancel their authorization at any time, as long as it is done in writing.

Q: Does completing Form 99 guarantee access to all medical records?
A: Completing Form 99 does not guarantee access to all medical records, as certain restrictions and limitations may apply.