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.Charlotte North Carolina Autorización para el Uso y Divulgación de Información de Salud Protegida bajo la REGLA 164.508 de HIPAA - Authorization for Use and Disclosure of Protected Health Information under HIPAA RULE 164.508
State:
Multi-State
City:
Charlotte
Control #:
US-02302BG
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Word
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