Florida Department of Elder Affairs Consent to Use or Disclose Health Information

Form Template

Patients can authorize the Department of Elder Affairs to use and disclose medical records for the purposes of treatment, payment and health care operations.

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Patients can simply fill out the Florida Department of Elder Affairs Consent to Use or Disclose Health Information app to give authorization. Treatment includes activities performed by a health care provider, nurse, office staff, and other types of health care professionals providing care to patients, coordinating or managing patient care with third parties, and consultations with and between other health care providers. Payment includes activities involved in determining patient eligibility for health plan coverage, billing and receiving payment for patient health benefit claims, and utilization management activities which may include review of health care services for medical necessity, justification of charges, pre-certification and pre-authorization. Health care operations includes the necessary administrative and business functions of our office.

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