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DOEA Form 187 Revocation of Authorization to Release Protected Health Information (Phi) - Florida
What Is DOEA Form 187?
This is a legal form that was released by the Florida Department of Elder Affairs - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 187?
A: Form 187 is the Revocation of Authorization to Release Protected Health Information (PHI) form in Florida.
Q: What does Form 187 do?
A: Form 187 allows an individual to revoke their authorization for the release of their protected health information in Florida.
Q: Why would someone need to use Form 187?
A: Someone may need to use Form 187 if they previously authorized the release of their protected health information but now wish to revoke that authorization in Florida.
Q: Is there a fee to submit Form 187?
A: There is generally no fee to submit Form 187 in Florida.
Q: Is Form 187 specific to Florida?
A: Yes, Form 187 is specific to the state of Florida. Other states may have different forms or requirements for revoking authorization to release protected health information.
Form Details:
- Released on April 1, 2003;
- The latest edition provided by the Florida Department of Elder Affairs;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of DOEA Form 187 by clicking the link below or browse more documents and templates provided by the Florida Department of Elder Affairs.
