Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Privacy Regulations written pursuant to the Act, the general rule is that covered entities may not use or disclose an individual's protected health information for purposes unrelated to treatment, payment, healthcare operations, or certain defined exceptions without first obtaining the individual's prior written authorization.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.