Section Ve-H 306.05 - Effect of Witnessed Signature on Page 6 of the ApplicationThe witnessed signature on page 6 of the application shall have the effect of:
(a) Confirming that the signer gives his or her permission for the medical providers and institutions indicated to:(1) Furnish to the home a copy of the applicant's medical record;(2) Allow the home to review the medical record; and(3) Furnish to the home specified additional pieces of information;(b) Confirming that the permission is for the specific purpose of consideration for admission to the home, and, if the applicant is admitted, for the specific purpose of continued care;(c) Confirming that the information is confidential shall be used only for the purposes stated, and shall not be re-released;(d) Requesting that the permission given by the applicant become invalid one year from the date of his or her signature; and(e) Confirming the applicant's understanding that his or her permission is subject to revocation at any time unless action on the permission has already begun in good faith.N.H. Admin. Code § Ve-H 306.05
Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12711, Effective 1/15/2019, Expires 1/15/2029.