Authorization to Verbally Discuss Protected Health Information
St. Cloud Surgical Center understands that privacy regulations have an impact on our customer service to you especially when it comes to discussing information about you with family, friends and others you designate who are involved in your care.
For us to better serve you and allow us to verbally communicate with those who are closest to you and your care, please complete the Authorization to Verbally Discuss Protected Health Information with Family and Friends. By you filling out this form in its entirety, it will allow us to talk about your care to those you have designated. This includes appointment and scheduling information, treatment information, billing information and any other pertinent information related to your care at St. Cloud Surgical Center.
How is this information on the form used?
Anytime a designated person calls on your behalf, we will verify the individual has your permission to receive the information and then will share the information.
Example of when this form might be useful:
- If an elderly patient wants an adult child to help understand medical treatment and instructions
- If a family member or friend is helping you with appointments, bills or understanding your care
- If a child over 18 years of age or an emancipated minor wants information shared with a parent
The Authorization to Verbally Discuss Protected Health Information form does NOT mean the individuals you designate can get copies of your medical records, you must complete a separate form for release of your medical records.
The Authorization to Verbally Discuss Protected Health Information form will not expire. The most current version of this form that we have on file, retained in your records will be honored by St. Cloud Surgical Center and its teammates. To revoke this authorization, we must receive it in writing at: St. Cloud Surgical Center, 1526 Northway Drive, St. Cloud, MN 56303
Due to recent Minnesota law changes, we are required to get signed consent before we can share information about your care with family and friends.
Please click on the link to print a pdf of the Verbal Authorization Form and email it to the address below:
Email to: scscauth@scasurgery.com