What is Form CHFS-305?
Form CHFS-305 is called the Authorization for Disclosure of Protected Health Information. The document is determined as a signed permission of the individual to allow an entity to make use or disclose the protected health information of the individual. There is a special Authorization Rule where you may find the description of the whole process. Covered entities can make use of this document.
What is the Purpose of Form CHFS-305?
The purpose of Form CHFS-305 is that the individual may disclose the protected health information. The form contains only one page and is not complicated. You do not need authorization for discloses that refer to health care operations, treatment, insurance functions, payments, as these all may be authorized by law.
When is Form CHFS-305 Due?
You must complete and file this form within ten days.
Is Form CHFS-305 Accompanied by Other Documents?
No. This form does not require any attachments. You may make several copies of the Authorization for Disclosure of Protected Health Information for your own records.
What Information do I Include in Form CHFS-305?
In the form you must indicate the following information:
- Name;
- Full address;
- Telephone number (home and work);
- Person to whom the records must be sent (name, address and telephone number);
- Social security number;
- Case record;
- Date of birth;
- The purpose of disclosure (choose from the offered list).
Where do I Send Form CHFS-305?
After the form is completed, send it to the Cabinet for Health and Family Services Commonwealth of Kentucky.
