Information Release

I hereby authorize Lirio Resources to share protected health information and identification including, but not limited to: name, address, phone number, social security number, date of birth, Medicaid number, and billing information to any Business Associate of Lirio Resources as deemed necessary for the coordination of my care.

I understand Lirio Resources abides by the Health Information Portability Accountability Act of 1996 to maintain compliance and assures that only the minimum necessary information to accomplish the intended purpose of the use, disclosure, or request shall be shared.

Lirio Resources follows the laws that tell us when we must share health information and when we can share health information without your permission. Lirio Resources will share information:

• As required by law
• To public health authorities to report such things as contagious diseases and for birth, death and immunization records.
• To the police or military as requested by law
• For court and administrative proceedings
• To health oversight authorities to see government programs are being conducted properly.
• Funeral directors or coroners
• For organ donation purposes
• To family, relative, or others who help in your care

Your rights:
• You have the right to request Lirio Resources limit the information they share about you, understanding Lirio Resources must share information deemed necessary to provide quality care.
• You have the right to receive your information from Lirio Resources privately and provided to the address and in the format of your choice.
• You have the right to inspect and copy your information that Lirio Resources has.
• You have the right to receive a list of the parties outside Lirio Resources that have received your information.