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Authorization to Disclose Health Information for the Division of Medicaid and Health Financing and the Department of Workforce Services - Utah
Authorization to Disclose Health Information for the Division of Medicaid and Health Financing and the Department of Workforce Services is a legal document that was released by the Utah Department of Health and Human Services - a government authority operating within Utah.
FAQ
Q: What is the Authorization to Disclose Health Information for the Division of Medicaid and Health Financing and the Department of Workforce Services in Utah?
A: The Authorization to Disclose Health Information is a document that allows the Division of Medicaid and Health Financing and the Department of Workforce Services in Utah to share your health information with other entities.
Q: Why would I need to sign an Authorization to Disclose Health Information?
A: You may need to sign this authorization if you want your health information to be shared between the Division of Medicaid and Health Financing and the Department of Workforce Services and other entities.
Q: What kind of information can be disclosed with this authorization?
A: With this authorization, your health information such as medical records, lab results, and treatment history can be shared.
Q: Who can receive my health information with this authorization?
A: Entities authorized by you, such as healthcare providers, insurance companies, or government agencies, can receive your health information.
Q: Can I revoke this authorization?
A: Yes, you have the right to revoke this authorization at any time by providing written notice to the Division of Medicaid and Health Financing or the Department of Workforce Services.
Form Details:
- Released on July 1, 2018;
- The latest edition currently provided by the Utah Department of Health and Human Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Utah Department of Health and Human Services.
