Request to Record Court Proceedings

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                                                                                                   AUTHORIZATION              DISCLOSURE
                                                                                                    FROM PATIENT               FORM AND
                                                                                                     TO DISCLOSE ACCOUNTING   FORWARD TO
                                        TYPE OF DISCLOSURE                                          PHI REQUIRED  REQUIRED        HIS
PHI to the individual                                                                                    YES        NO**          NO
For treatment, payment, or health care operations                                                         NO         NO           NO
With an authorization from the individual                                                                YES        NO**          NO
With a verbal agreement from the individual (facility directory, person involved in care) or for
notification or emergency circumstances                                                               VERBAL         NO          NO
Incidental disclosures (when overheard at a nursing station, etc.)                                      NO           NO          NO
For national security or intelligence purposes                                                          NO           NO          NO
To correctional institutions                                                                            NO           NO          NO
To law enforcement officials for law enforcement activities (when they request the PHI)                 NO          YES          YES
To a 3rd party contracted to perform audits                                                             NO           NO          NO
To JCAHO for accreditation purposes                                                                     NO           NO          NO
When reporting a crime to law enforcement agencies (gunshot wounds, etc.)                               NO          YES          YES
For review by MUSC OHCA Legal Departments                                                               NO           NO          NO
For reporting vital statistics (births and deaths)                                                      NO          YES          YES
For other disclosures not listed on this page                                                           YES         NO**         NO
To HHS for investigations                                                                               NO          YES          YES
In the course of judicial and administrative proceedings (court orders or subpoenas)                    NO          YES          YES
For public health activities for disclosures related to victims of child abuse or neglect               NO          YES          YES
For public health activities for disclosures to prevent or control disease (required by law)            NO          YES          YES
To coroners, medical examiners, and funeral directors                                                   NO          YES          YES
For cadaveric organ donation                                                                            NO          YES          YES
To advert a serious threat to health or safety                                                          NO          YES          YES

If requesting a copy of ENTIRE medical record, send the individual to HIS (Medical Records)

**Since a patient's authorization is required prior to disclosing/releasing this
information, an accounting of the disclosure is NOT required

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