----- Each informed consent ----- ----- ----- ----- document shall include a statement that the patient has a right to inspect and receive a copy of the material to be disclosed: DHS 92.03(3)(d) ----- Any patient or patient Authorization ----- ----- A statement placing the representative may withdraw contains a individual on notice of the authorization for disclosure of statement that the individual's right to revoke any information at any time. consent is subject the authorization in writing, to revocation at and either If this occurs, an agency not any time except to included under s.51.30(4)(b) The exceptions to the • the extent that the Stats., that requests release of right to revoke and how part 2 program or information requiring informed to revoke other lawful holder consent shall be told only that [164.508(b)(5)], or of patient s. 51.30, Stats., prohibit release If the right to revoke is in • identifying of the information requested. the notice, a reference to information that is the notice. DHS 92.03(3)(e) permitted to make 164.508(c)(2) the disclosure has already acted in (i) Note: An individual reliance on it. may revoke an Acting in reliance authorization by includes the providing a revocation in provision of writing to the disclosing CE, treatment services except to the extent: 1) the in reliance on a disclosing CE has taken valid consent to action in reliance on the disclosure authorization or 2) if the information to a authorization was obtained third-party payer: as a condition of obtaining 2.31(a)(6) insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.
----- Each informed consent document shall include a statement that the patient has a right to inspect and receive a copy of the material to be disclosed: DHS 92.03(3)(d) ----- ----- ----- ----- ----- Any patient or patient representative may withdraw authorization for disclosure of any information at any time. If this occurs, an agency not included under s.51.30(4)(b) Stats., that requests release of information requiring informed consent shall be told only that s. 51.30, Stats., prohibit release of the information requested. DHS 92.03(3)(e) Authorization contains a statement that the consent is subject to revocation at any time except to the extent that the part 2 program or other lawful holder of patient identifying information that is permitted to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclosure information to a third-party payer: 2.31(a)(6) ----- ----- A statement placing the individual on notice of the individual's right to revoke the authorization in writing, and either • The exceptions to the right to revoke and how to revoke [164.508(b)(5)], or • If the right to revoke is in the notice, a reference to the notice. 164.508(c)(2) (i) Note: An individual may revoke an authorization by providing a revocation in writing to the disclosing CE, except to the extent: 1) the disclosing CE has taken action in reliance on the authorization or 2) if the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.
HCR-Authorization-Elements-Grid-4.4.18.docx