Authorization to Disclose PHI

How to have Results Released

The information we gather and use about you may be protected under a Law created by President Clinton named the Health Insurance Portability and Affordability Act (HIPAA) of 1996, and its amendments made by Presidents Bush and Obama.  

  • PHI is Protected Health Information.
  • Protected Health Information is information that was created or received by a "Covered Entity" and that is health care data that also contains information that can be used to identify the individual that it relates to.
  • A covered entity is one of the below
    • Health care provider,
    • Health plan,
    • Public health authority,
    • Insurer,
    • Employer,
    • School or university or
    • Health care clearinghouse.
  • Health Care Data is data that relates to a mental or physical condition, or to the provision of health care to an individual


The Lab Orders that Precision Labs Receives and the Lab Reports that we produce are Protected Health Information.  Because of the HIPAA rules, we are required to document carefully, who is authorized to receive your information, and to whom we disclose this information.  You can get more information about this from our Patient Privacy Notice.

In order to disclose information to someone other than you, we need to have documentation that you have authorized this.  The form available from the button below is used to collect the information we require.

We also need one of two things to happen in order to authenticate the request is valid.

  • Option 1.  You need to present the form in person with a government issued photo ID so that we can directly verify that you are who you claim to be
  • Option 2.  You can present your identity to a notary public and have the request notarized, then you can mail us the notarized form.


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