Bexar Texas Autorización para la divulgación de información personal - Authorization for Release of Personal Information
Description
How to fill out Bexar Texas Autorización Para La Divulgación De Información Personal?
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FAQ
La autorizacion proporcionada al usar el formulario significa que la organizacion, entidad o persona autorizada puede divulgar, comunicar o enviar la informacion medica protegida de la persona nombrada a la organizacion, entidad o persona identificada en el formulario, inclusive usando cualquier metodo electronico.
Empieza poniendo "Yo," seguido de tu nombre y apellidos y numero de DNI (o de pasaporte) y tambien tu domicilio, si lo estimas necesario. Continua el escrito con "autorizo a", anade el nombre y el DNI de la persona autorizada, y a continuacion indica la accion concreta que esa persona va a realizar en tu nombre.
Autorizacion para Divulgar Informacion divulgar mi informacion de salud individualmente identificable a las siguientes personas u organizaciones: Escriba el nombre y la direccion de cada persona que usted autorice a Optum a divulgar informacion relacionada con su atencion.
