TX HHS Form 2870. Permission to Disclose Protected Health and Other Confidential Information

The TX HHS Form 2870, "Permission to Disclose Protected Health and Other Confidential Information," is a crucial document that enables individuals to authorize the disclosure of their protected health information and other confidential data. This form is typically used in situations where an individual needs to share their personal health information with healthcare providers, social services, or government agencies for the purpose of developing a service plan.

The form requires specific information from the individual, including their name, date of birth, Social Security number, and contact details. The individual must also acknowledge that they have been informed about the purposes for which their protected health information will be used, including the development of their service plan and other agency purposes. Key features of the form include the ability to authorize disclosure of specific types of information, such as consultation reports, diagnostic test results, and educational records.

By completing this form, individuals can ensure that their protected health information is shared with authorized parties in accordance with applicable laws and regulations. The form also includes provisions for revoking authorization at any time, as well as procedures for handling situations where the individual refuses to sign or withdraws their consent. Key points to note include:

• The form is used to authorize disclosure of protected health information and other confidential data.
• The individual must provide specific information about themselves, including name, date of birth, and contact details.
• The form requires the individual's acknowledgement of the purposes for which their protected health information will be used.
• The individual has the right to revoke authorization at any time.