Form SFN54044 Authorization for Disclosure of Protected Health Information - North Dakota

What Is Form SFN54044?

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

FAQ

Q: What is Form SFN54044?
A: Form SFN54044 is the Authorization for Disclosure of Protected Health Information in North Dakota.

Q: What is the purpose of Form SFN54044?
A: The purpose of Form SFN54044 is to authorize the disclosure of protected health information.

Q: Who needs to complete Form SFN54044?
A: Any individual who wants to authorize the disclosure of their protected health information needs to complete and sign Form SFN54044.

Q: Is Form SFN54044 specific to North Dakota?
A: Yes, Form SFN54044 is specific to the state of North Dakota and is compliant with North Dakota laws and regulations regarding the disclosure of protected health information.

Q: What information is required on Form SFN54044?
A: Form SFN54044 requires the individual's name, date of birth, address, contact information, details about the healthcare provider or entity releasing the information, and specific information about the information being disclosed.

Q: How long is Form SFN54044 valid?
A: Form SFN54044 is typically valid for one year from the date of signature, unless otherwise specified.

Q: Can Form SFN54044 be revoked?
A: Yes, an individual can revoke their authorization for disclosure of protected health information by submitting a written revocation to the healthcare provider or entity who received the original authorization.

Q: Are there any fees associated with submitting Form SFN54044?
A: Fees may be associated with the processing of Form SFN54044, depending on the policies of the healthcare provider or entity receiving the authorization. It is recommended to inquire about any potential fees before submitting the form.

Q: Is Form SFN54044 required for every disclosure of protected health information?
A: Form SFN54044 is not required for every disclosure of protected health information. It is only necessary when an individual wants to authorize the disclosure of their specific health information to a specific healthcare provider or entity.