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Application-Birthmother-HIPAA

BP HIPAA

  • MEDICAL RECORDS AUTHORIZATION

  • Per the United States Department of Health and Human Services pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I hereby authorize any medical practitioner or facility or related entity to give Abby’s One True Gift Adoptions Inc. any of the following;

    Verification of any documentation presented to them by me which substantiates my current condition as it relates to pregnancy.

    Medical information, records and data about me related to pregnancy.

    The entire medical file for the last three years not excluding; medical information, records and data, alcohol and drug use and/or abuse, and drugs prescribed.

    Information, records and data about me relating to mental illness, other than psychotherapy notes.