HIPAA Authorization Revocation
$7.99
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HIPAA Authorization Revocation
$7.99
Digital download
Available immediately after purchase for easy download.
- Attorney-drafted forms
- State-specific guidance after registration
- 30-day money-back guarantee
Harner Legal Forms provides self-help legal forms and general information, not legal advice.
Harner Legal Forms
About this kit
The Harner Legal Forms HIPAA Authorization Revocation is an attorney-prepared, downloadable legal form for withdrawing a prior written HIPAA authorization that allowed specified people or organizations to use or disclose protected health information.
The package includes both a Revocation and a separate Notice of Revocation. The Revocation identifies the individual, the prior HIPAA authorization, and the person or organization previously authorized to receive protected health information. The Notice can then be sent to healthcare providers, health plans, facilities, business associates, and other recipients that may have relied on the prior authorization.
A revocation generally becomes effective as to a covered entity when that entity receives the written revocation, and it generally does not undo disclosures or other actions already taken in reasonable reliance on the prior authorization. The included instructions explain how to identify the prior authorization, prepare notices for recipients, document delivery, and retain records of what was sent.
What’s included
- HIPAA Authorization Revocation form
- Notice of Revocation form
- Step-by-step instructions for completing, signing, delivering, and documenting the revocation
Key features
- Attorney-prepared and professionally formatted
- Revokes a prior HIPAA Authorization in writing
- Includes a separate Notice of Revocation for healthcare providers and other recipients
- Helps document delivery and notice
- Easy-to-complete fill-in format
- Instant digital download
Federal HIPAA rules, state medical-privacy laws, and recipient procedures may affect the scope and effectiveness of a revocation. Review the included instructions and any applicable state-specific requirements before completing and using the form.
