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01/11/2019
Standard Authorization Form now available on ODM website
Standard Authorization Form Now Available on ODM Website
There is now a Standard Authorization Form (Form Number: ODM 10221) available, designed to improve patient care across multiple providers by making it easier to share protected health information in a secure manner. The form is applicable to all covered entities in Ohio.
It is not required to be used, however, a properly executed form must be accepted by the receiving entity. The requirement to accept a properly executed form is applicable within 30 days of Jan. 3, 2019.
- Standard Authorization Form
- Instructions for Completing Standard Authorization Form
- Additional details about the Standard Authorization Form are available in the fact sheet
- Questions about the Standard Authorization Form may be directed to StandardAuthForm@medicaid.ohio.gov
- Introductory video on the Standard Authorization Form
- Instructional video on the Standard Authorization Form
The form is available on the Ohio Department of Medicaid website under the Provider Tab.