Collin Texas Solicitud de Restricciones de Usos y Divulgaciones de Información de Salud Protegida - Request for Restrictions on Uses and Disclosures of Protected Health Information

State:
Multi-State
County:
Collin
Control #:
US-3582
Format:
Word
Instant download

Description

This form is used by an individual to request restrictions on the disclosure and use of the individual's protected health information. The individual's rights regarding restricting such use and disclosure are explained, as well as the responsibilities of the record provider in regard to the restrictions. 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.
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FAQ

Garantiza los derechos a la privacidad del paciente al entregar explicaciones claras por escrito de como el proveedor podria utilizar y revelar su informacion de salud. Asegurar que los pacientes puedan ver y obtener copias de sus expedientes y poder solicitar correcciones.

La Norma de Privacidad de la ley HIPAA protege la privacidad de la informacion medica de los pacientes (informacion de salud protegida), pero esta equilibrada para garantizar que se haga el uso y la revelacion adecuados de la informacion cuando sea necesario para tratar a un paciente, proteger la salud publica de la

Protegida (Protected Health Information, PHI) formulario de Autorizacion para la divulgacion de informacion medica protegida.

La Norma de Privacidad tambien otorga a las personas algunos derechos respecto de su informacion de salud, como, por ejemplo, el derecho a acceder o solicitar correcciones en su informacion.

PHI es una sigla en ingles que significa informacion medica protegida.

Entidad cubierta: pueden ser planes de salud, oficinas de compensacion para atencion medica y algunos proveedores de atencion medica que transmitan en forma electronica informacion medica en transacciones estandar, como, por ejemplo, en el caso de las operaciones de facturacion.

Puede revocar, por escrito, la autorizacion que nos otorgo para el uso o divulgacion de su PHI. Sin embargo, si nos hemos basado en su consentimiento o autorizacion, podemos usar o divulgar su PHI hasta el momento en que revoque su consentimiento.

Informacion de Salud Protegida (PHI) significa informacion que lo identifica a usted individualmente; incluyendo informacion demografica e informacion relacionada con su condicion de salud fisica o mental pasada, presente o futura o servicios de atencion medica relacionados.

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Collin Texas Solicitud de Restricciones de Usos y Divulgaciones de Información de Salud Protegida