The UCLA 30910 form, a pivotal document within the healthcare system, facilitates the controlled release of protected health information (PHI) to specified recipients under the patient's directive. By meticulously specifying the type of records to be released—ranging from medical and mental health records to billing statements and laboratory reports—the form plays a crucial role in ensuring that sensitive health information is shared responsibly and with explicit consent. It accommodates requests for record delivery through various modes, including CDs, paper copies, or emails (with noted exceptions), and clearly outlines the proposed recipient of the information, whether it be another healthcare facility, a designated individual, or for other specified reasons. The form further empowers patients through the ability to revoke the authorization at any point, underscoring the emphasis on patient autonomy and privacy. Sensitive information, such as details pertaining to drug and alcohol abuse, genetic testing, or HIV/AIDS test results, is handled with an additional layer of discretion, requiring specific authorization for release. The form's design reflects a comprehensive approach to the management of PHI, adhering to legal requirements while prioritizing patient rights and the confidentiality of their health information.
| Question | Answer |
|---|---|
| Form Name | Ucla 30910 Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | ucla medical release, ucla release form, ucla medical records form, ucla medical records |