Utah Request for Restrictions on Uses and Disclosures of Protected Health Information

State:
Multi-State
Control #:
US-3582
Format:
Word; 
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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.
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How to fill out Request For Restrictions On Uses And Disclosures Of Protected Health Information?

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FAQ

Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat).

HIPAA Exceptions DefinedTo public health authorities to prevent or control disease, disability or injury. To foreign government agencies upon direction of a public health authority. To individuals who may be at risk of disease. To family or others caring for an individual, including notifying the public.

Regardless of the method by which de-identification is achieved, the Privacy Rule does not restrict the use or disclosure of de-identified health information, as it is no longer considered protected health information, according to HHS.

The Privacy Rule permits use and disclosure of protected health information, without an individual's authorization or permission, for 12 national priority purposes.

A covered entity may disclose protected health information to the individual who is the subject of the information. (2) Treatment, Payment, Health Care Operations. A covered entity may use and disclose protected health information for its own treatment, payment, and health care operations activities.

Under the new rule, individuals now have a right to obtain restrictions on the disclosure of health information (protected health information or PHI) in electronic or any other form to a health plan for payment or healthcare operations with respect to specific items and services for which the individual has paid the

Since its initial adoption, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule has granted individuals the right to request restrictions regarding the use and disclosure of their protected health information (PHI) for treatment, payment, and healthcare operations (TPO).

A covered entity is required to agree to an individual's request to restrict the disclosure of their PHI to a health plan when both of the following conditions are met: (1) the disclosure is for payment or health care operations and is not otherwise required by law; and (2) the PHI pertains solely to a health care item

We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

To disclose patient information, healthcare executives must determine that patients or their legal representatives have authorized the release of information or that the use, access or disclosure sought falls within the permitted purposes that do not require the patient's prior authorization.

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Utah Request for Restrictions on Uses and Disclosures of Protected Health Information