(1) The Universal Patient Authorization Form for Full Disclosure of Health Information for Treatment and Quality of Care including instructions for completing the form is posted at: www.FHIN.net. The form may be printed, completed, signed and scanned into an electronic format as provided in subsection 59B-16.001(2), F.A.C. The Universal Patient Authorization Form for Full Disclosure of Health Information for Treatment and Quality of Care, Form Florida AHCA FC4200-004 7.1.2011 is incorporated by reference and the Spanish language version, Formulario de Autoización Universal para Dar a Conocer Información Médica Completa para Tratamiento & Calidad de Cuidado, Form Florida AHCA FC4200-006 7.1.2011, https://www.flrules.org/gateway/reference.asp?NO=Ref-01202, is incorporated by reference.
    (2) The Universal Patient Authorization Form for Limited Disclosure of Health Information including instructions for completing the form is posted at: www.FHIN.net. The form may be printed, completed, signed and scanned into an electronic format as provided in subsection 59B-16.001(2), F.A.C. The Universal Patient Authorization Form for Limited Disclosure of Health Information, Form Florida AHCA FC4200-005 7.1.2011 is incorporated by reference and the Spanish language version, Formulario de Autoización Universal para Dar a Conocer Información Médica Completa para Tratamiento & Calidad de Cuidado, Form Florida AHCA FC4200-006 7.1.2011, https://www.flrules.org/gateway/reference.asp?NO=Ref-01202.
Rulemaking Authority 408.051(4)(b), 408.15(8) FS. Law Implemented 408.051(4) FS. History-New 7-28-10, Amended 5-14-12.