Mi revocación tendrá vigencia cuando se reciba, excepto en la medida en que otras personas hayan actuado basados en esta autorización.
- Tengo el derecho de recibir una copia de esta autorización.4
- El destinatario de la información divulgada en virtud de esta autorización puede volver a divulgarla. Dicha nueva divulgación en algunos casos no es +prohibido por la ley del Estado de California, y puede no estar protegida por la ley federal de confidencialidad
2 of a refusal to sign the authorization when that covered entity can condition treatment, health plan enrollment, or benefit eligibility on the failure to obtain such authorization. A covered entity is permitted to condition treatment, health plan enrollment or benefit eligibility on the provision of an authorization as follows: (i) to conduct research-related treatment, (ii) to obtain information in connection with a health plan’s eligibility or enrollment determinations relating to the individual or for its underwriting or risk rating determinations, or (iii) to create health information to provide to a third party or for disclosure of the health information to such third party. Under no circumstances, however, may an individual be required to authorize the disclosure of psychotherapy notes. 3Patients of federally-assisted substance abuse programs and patients whose records are covered by LPS may revoke an authorization verbally. 4Under HIPAA, the individual must be provided with a copy of the authorization when it has been requested by a covered entity for its own uses and disclosures (see 45 C.F.R. Section 164.508(c4.
If any of the HIPAA recognized exceptions to this statement applies, then this statement must be changed to describe the consequences to the individual
California Hospital Association