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Universal Authorization to release medical information

Electronic Form

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To improve patient care, Geisinger shares your medical information with providers involved in your healthcare as permitted under HIPAA.

Geisinger considers your privacy to be very important, and we will take steps to limit the release of certain sensitive data without your consent.  This includes substance use disorder, HIV/AIDs, and inpatient mental health records.

We also believe that your doctors need a complete picture of your health, that we should make payment of claims easier, and that we need to improve the quality of our care and the services we provide. That is why we ask you to consider signing our Universal Authorization for the Release of Medical Information.  

When you sign the “Universal Authorization for Release of Medical Information”, you give Geisinger permission to use and share your sensitive PHI in the same ways we use your other medical information in accordance with HIPAA and our Notice of Privacy Practices.

You can revoke or cancel this authorization in writing at any time.

Frequently Asked Questions

If I sign this authorization, who will see my Geisinger sensitive data?
With this signed authorization, we will only use and share your sensitive data as allowed under HIPAA. This includes treatment purposes, payment purposes, healthcare operations and certain other limited situations as outlined in our Notice of Privacy Practices.

How will this improve my care?
By having your authorization on file at Geisinger:

  • Your doctors will have access to your complete medical record to make the best decisions on how to treat you better coordinate your care for improved medical outcomes and patient safety
  • In some cases, we will be able to bill your insurance company for services rendered without additional paperwork or delay
  • We will use this information to evaluate the quality of our care and to improve our services