Form DMA-7097-ia Request and Authorization to Disclose Health Information - North Carolina

What Is Form DMA-7097-ia?

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

FAQ

Q: What is DMA-7097-ia?
A: DMA-7097-ia is a form used in North Carolina to request and authorize the disclosure of health information.

Q: What is the purpose of the DMA-7097-ia form?
A: The purpose of the DMA-7097-ia form is to give permission for the release of your health information to specific individuals or organizations.

Q: Who should use the DMA-7097-ia form?
A: Any individual in North Carolina who wishes to have their health information disclosed to others should use the DMA-7097-ia form.

Q: Does the DMA-7097-ia form expire?
A: The expiration date of the DMA-7097-ia form may vary and is typically determined by the healthcare provider or the entity requesting the disclosure.

Q: Are there any fees associated with the DMA-7097-ia form?
A: Fees for releasing health information may apply, depending on the healthcare provider or entity in possession of the information.

Q: What information is required on the DMA-7097-ia form?
A: The DMA-7097-ia form will typically require your name, date of birth, contact information, and a description of the health information being requested.

Q: Can I revoke my authorization on the DMA-7097-ia form?
A: Yes, you can revoke your authorization by submitting a written request to the healthcare provider or entity to which you granted permission.

Q: Can I use the DMA-7097-ia form for other states?
A: No, the DMA-7097-ia form is specific to North Carolina. Other states may have different forms or requirements for authorizing the disclosure of health information.

Q: Is the DMA-7097-ia form mandatory?
A: The use of the DMA-7097-ia form is generally not mandatory, but it is commonly used when requesting the disclosure of health information in North Carolina.