Minnesota Revocación de autorización para usar o divulgar información de salud protegida - Revocation of Authorization To Use or Disclose Protected Health Information

• Category: Confidencialidad y no divulgación - Contratos - Información de salud protegida (HIPAA)
• State: Multi-State
• Control #: US-3579
• Format: Word

Description

Revocation of Authorization To Use or Disclose Protected Health Information

Minnesota Revocation of Authorization to Use or Disclose Protected Health Information is a legal document that allows an individual to withdraw their consent for the use or disclosure of their protected health information (PHI) by healthcare providers, insurers, or other entities under the Health Insurance Portability and Accountability Act (HIPAA) regulations. This revocation is specific to Minnesota state law. The purpose of the Minnesota Revocation of Authorization is to empower individuals with control over their private health information, providing them with the ability to restrict its use or dissemination. It ensures that healthcare providers or other covered entities cannot continue to use or share an individual's PHI without their explicit consent. By completing a Revocation of Authorization form, an individual effectively overturns any previous consent given for healthcare providers or entities to access, use, or disclose their protected health information. This revocation applies to both electronic and paper-based PHI and may include medical records, treatment plans, laboratory results, insurance claims, or any other health-related information. The Minnesota Revocation of Authorization to Use or Disclose Protected Health Information document includes several essential elements. These typically encompass: 1. Individual's Information: The form begins by collecting the individual's personal details, such as their full name, address, date of birth, and any unique identifiers that may assist in identifying the records. 2. Description of Authorization: The document specifies the previous authorization, outlining the date it was executed, who it was provided to, and any specific limitations or conditions that were agreed upon. 3. Revocation Statement: This section clearly states the individual's intent to revoke previously granted authorization for the use or disclosure of their protected health information. The language must be clear and unambiguous to avoid any confusion regarding the intent to revoke consent. 4. Effective Date: The date on which the revocation becomes effective is provided, ensuring that the individual's wishes are implemented promptly. 5. Signature and Date: The individual must sign and date the form to authenticate their revocation of authorization. It is important to note that while the Minnesota Revocation of Authorization creates a legal obligation for healthcare providers and covered entities to halt the use or disclosure of an individual's PHI going forward, it does not affect any actions taken based on previously authorized use or disclosure. Furthermore, the revocation may not apply to certain situations where the law requires the use or disclosure of PHI, such as for public health emergencies or legal proceedings. While there may not be specific types of Minnesota Revocation of Authorization to Use or Disclose Protected Health Information documents, variations may arise depending on the purpose for which the authorization was initially given and the specific entity involved. However, the content and fundamental elements of the form remain consistent across any revocation document used in Minnesota.

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.