Forms Pt’s Sign

Question 1

This form is signed notifying a patient of how the health care organization may use and share health information and also includes the patient’s health privacy rights.

Answer 1

The notice of privacy practice

Question 2

This form is signed by the patient to allow the third-party payer to be billed by the medical provider and direct payment made to the medical provider.

Answer 2

Assignment of benefits (AOB)

Question 3

Written statements of a person’s wishes regarding treatment, such as a living will

Answer 3

Advance directive

Question 4

This form gives authorization for the medical provider to share the patient’s medical information with a specified person stated by the patient

Answer 4

Medical release form