1(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 26posted at: 28www.FHIN.net29. The form may be printed, completed, signed and scanned into an electronic format as provided in subsection 4759B-16.001(2), 48F.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, 102https://www.flrules.org/gateway/reference.asp?NO=Ref-01202, 104is incorporated by reference.
108(2) The Universal Patient Authorization Form for Limited Disclosure of Health Information including instructions for completing the form is posted at: 129www.FHIN.net130. The form may be printed, completed, signed and scanned into an electronic format as provided in subsection 14859B-16.001(2), 149F.A.C.150The Universal Patient Authorization Form for Limited Disclosure of Health Information, 161Form Florida AHCA FC4200-005 7.1.2011 166is incorporated by reference 170and 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, 197https://www.flrules.org/gateway/reference.asp?NO=Ref-01202199.
