Disclosure of Information – Insurance Companies - Western Health
Disclosure of Information – Insurance Companies - Western Health
Disclosure of Information – Insurance Companies - Western Health
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NUMBER: 9 <strong>–</strong> 02 <strong>–</strong> 25PAGE 4 <strong>of</strong> 4KEYWORDS<strong>Insurance</strong> companies, releasing information to insurance companiesFORMSConsent to Disclose/Obtain <strong>Information</strong> (#12-475)TO BE COMPLETED BY QUALITY MANAGEMENT & RESEARCH STAFF ONLYApproved By:Maintained By:Chief Executive OfficerRegional Manager, <strong>Information</strong> Access and PrivacyEffective Date: Reviewed: 12/October/201126/October/2008 Revised: 02/March/2012Review Date: Replaces: (Indicates name and number <strong>of</strong> policybeing replaced)02/March/2015Authorization for Release <strong>of</strong> <strong>Information</strong> <strong>–</strong>Standard/Form (RR-A-200), Release <strong>of</strong> <strong>Information</strong>from Clinical Records (AD-R-200), Consent toRelease/Obtain <strong>Information</strong> (Form 12-390), Release<strong>of</strong> <strong>Information</strong> (Former HCSW policy 18-06-25) New
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