Authorization to Revoke Release of Health Information - Arkansas

Authorization to Revoke Release of Health Information is a legal document that was released by the Arkansas Department of Transformation and Shared Services - a government authority operating within Arkansas.

FAQ

Q: What is the Authorization to Revoke Release of Health Information?A: The Authorization to Revoke Release of Health Information is a legal document that allows an individual to cancel a previous authorization for the release of their health information.

Q: Who can use the Authorization to Revoke Release of Health Information?A: Any individual who has previously authorized the release of their health information can use this form to revoke that authorization.

Q: Do I need a reason to revoke the release of my health information?A: No, you do not need to provide a reason for revoking the release of your health information.

Q: How do I complete the Authorization to Revoke Release of Health Information?A: You need to provide your personal information, including your name, date of birth, and contact information. You will also need to include the date and details of the original authorization you want to revoke.

Q: Is there a fee to submit the Authorization to Revoke Release of Health Information form?A: There is usually no fee to submit this form, but you should confirm with your healthcare provider or the Arkansas Department of Health.

Q: What happens after I submit the Authorization to Revoke Release of Health Information form?A: Once you submit the form, the previous authorization for the release of your health information will be revoked, and healthcare providers will no longer be allowed to share your information based on that authorization.

Q: Can I change my mind after submitting the Authorization to Revoke Release of Health Information form?A: Yes, you can change your mind at any time and authorize the release of your health information again.

Q: How long does it take for the revocation to take effect?A: The revocation should take effect immediately after it is submitted, but you should confirm with your healthcare provider or the Arkansas Department of Health.