Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)

Eligibility Policy - 10/25/2021

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2010.05 Release of Protected Health Information - An individual may grant a specific person or organization to share and receive information concerning the case. This does not give authority to act on behalf of the individual, or request a fair hearing on behalf of the individual.

A signed written authorization from the person for whom they are requesting to share or receive information must be obtained. The Release of Protected Health Information form may be used for this purpose and must be signed by the adult. The length of appointment shall be the date entered on line 8 of the form, or 12 months, whichever is shorter.

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