Form MO375-0195 Authorization to Use and Disclose Protected Health Information Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) - Missouri

What Is Form MO375-0195?

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

FAQ

Q: What is Form MO375-0195?
A: Form MO375-0195 is a document used to authorize the use and disclosure of protected health information under HIPAA in Missouri.

Q: What is HIPAA?
A: HIPAA stands for Health Insurance Portability and Accountability Act, a federal law that protects the privacy and security of health information.

Q: What is protected health information?
A: Protected health information (PHI) includes any individually identifiable health information, such as medical records or personal health information.

Q: When is Form MO375-0195 used?
A: Form MO375-0195 is used when an individual wants to authorize the use and disclosure of their protected health information for a specific purpose.

Q: Do I need to fill out Form MO375-0195?
A: If you want to authorize the use and disclosure of your protected health information under HIPAA in Missouri, then you will need to fill out this form.

Q: Is Form MO375-0195 specific to Missouri?
A: Yes, Form MO375-0195 is specifically used in the state of Missouri to comply with state and federal privacy laws.

Q: What are the consequences of not following HIPAA guidelines?
A: Failure to comply with HIPAA guidelines can result in legal penalties, including fines and potential criminal charges.

Q: How long is the authorization valid?
A: The duration of the authorization is specified in the form, but typically it remains valid until the expiration date or the revocation of the authorization by the individual.

Q: Can I revoke the authorization?
A: Yes, you have the right to revoke the authorization at any time by submitting a written request to the healthcare provider or organization that received the original authorization.