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. An individual may revoke an authorization at any time, provided that the revocation is in writing, unless the health care provider has already provided personal health information based on the patients authorization. The health care provider should stop providing information based on a patients authorization as soon as possible.
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.Jersey City New Jersey Revocación de la Autorización de HIPAA bajo la Regla HIPAA 164.508 - Revocation of HIPAA Authorization under HIPAA Rule 164.508
State:
Multi-State
City:
Jersey City
Control #:
US-02303BG
Format:
Word
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