{"id":9496,"date":"2020-12-09T17:09:21","date_gmt":"2020-12-09T23:09:21","guid":{"rendered":"https:\/\/countycare1.wpenginepowered.com\/?page_id=9496"},"modified":"2025-07-02T13:38:07","modified_gmt":"2025-07-02T18:38:07","slug":"hipaa-phi-forms","status":"publish","type":"page","link":"https:\/\/countycare.com\/es\/hipaa-phi-forms\/","title":{"rendered":"Formularios Phi de HIPAA"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"9496\" class=\"elementor elementor-9496\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8ba00b1 e-flex e-con-boxed e-con e-parent\" data-id=\"8ba00b1\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-bd160b4 e-con-full e-flex e-con e-child\" data-id=\"bd160b4\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cda819f elementor-widget elementor-widget-heading\" data-id=\"cda819f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">HIPAA &amp; Privacy Forms<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-145b78c elementor-widget elementor-widget-heading\" data-id=\"145b78c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">The Health Insurance Portability and Accountability Act (HIPAA) ensures your access to various health and human services, and it protects the privacy and security of your medical records and information.<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b200ea elementor-widget elementor-widget-heading\" data-id=\"7b200ea\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">As a health plan, CountyCare regularly communicates with your provider about your care, and we follow strict guidelines outlined by HIPAA.<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-bd83c76 e-flex e-con-boxed e-con e-parent\" data-id=\"bd83c76\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;gradient&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-1e79c64 e-con-full e-flex e-con e-child\" data-id=\"1e79c64\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-bc88148 e-flex e-con-boxed e-con e-parent\" data-id=\"bc88148\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-88697d6 e-con-full e-flex e-con e-child\" data-id=\"88697d6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2d7ea63 elementor-widget elementor-widget-heading\" data-id=\"2d7ea63\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Estos formularios pueden ayudarlo a:<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ea7ca3a elementor-widget elementor-widget-text-editor\" data-id=\"ea7ca3a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul>\n<li>Dar permiso a CountyCare para discutir o divulgar informaci\u00f3n personal y de salud o para compartir informaci\u00f3n\/documentos para un prop\u00f3sito espec\u00edfico&nbsp;<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/AUTHORIZATION-TO-DISCLOSE-PHI-012125.pdf\">(Autorizaci\u00f3n para divulgar informaci\u00f3n de salud protegida (PHI)<\/a>&nbsp;<span class=\"translations-wrapper\"><span class=\"translations\"><i class=\"fa fa-level-up fa-rotate-90\"><\/i>&nbsp;Disponible en otros idiomas:&nbsp;<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CountyCare_0126_PHI_Authorization_Form-SP-061623.pdf\">es<\/a><\/span><\/span>)<\/li>\n<li>Evitar que CountyCare discuta o divulgue su informaci\u00f3n personal de salud con un individuo o grupo previamente autorizado (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_RevocationOfAuthToDisclosePHI_English_012125.pdf\">Revocaci\u00f3n de autorizaci\u00f3n para divulgar informaci\u00f3n de salud protegida (PHI)<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Dar permiso para que sus proveedores de tratamiento por abuso de sustancias compartan informaci\u00f3n con otros miembros de su equipo de atenci\u00f3n m\u00e9dica (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_AuthToDiscloseSubstanceUseInfo_English_030818.pdf\" target=\"_blank\" rel=\"noopener\">Autorizaci\u00f3n para divulgar informaci\u00f3n de salud confidencial sobre trastornos por uso de sustancias<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Solicite un informe de cu\u00e1ndo CountyCare divulga su informaci\u00f3n de salud personal por razones distintas a las de Tratamiento, Pago u Operaciones de atenci\u00f3n m\u00e9dica, o para divulgaciones realizadas con su autorizaci\u00f3n o permiso (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_RequestAccountingPHIDisclosures_English_012125.pdf\">Solicitud de contabilidad de divulgaciones de informaci\u00f3n m\u00e9dica protegida (PHI)<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Solicitar una enmienda a su informaci\u00f3n m\u00e9dica mantenida por CountyCare o entidades en nombre de CountyCare (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_RequestAmendPHI_English_012125.pdf\">Solicitud para modificar la informaci\u00f3n m\u00e9dica protegida (PHI)<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Solicitar que CountyCare restrinja las divulgaciones de su informaci\u00f3n m\u00e9dica o solicitar que CountyCare proporcione su informaci\u00f3n m\u00e9dica protegida (PHI) por medios alternativos o en ubicaciones alternativas (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_PHICommunicationRequest_English_012125.pdf\">Solicitud de comunicaci\u00f3n de informaci\u00f3n m\u00e9dica protegida (PHI)<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Otorga permiso a CountyCare para usar su nombre y \/ o historia en sus medios de comunicaci\u00f3n, materiales educativos o promocionales (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCR_MemberReleaseForPromo-EduActivities_English_061417.pdf\" target=\"_blank\" rel=\"noopener\">Autorizaci\u00f3n y divulgaci\u00f3n de miembros para actividades educativas y promocionales<\/a>)<\/li>\n<li class=\"nitro-offscreen\">Dar permiso para compartir su informaci\u00f3n de contacto y necesidades de vivienda compartidas con las Agencias de Asistencia de Vivienda (<a href=\"https:\/\/countycare.com\/wp-content\/uploads\/CCH-Authorization-to-Disclose-PHI_2019-01-25_cco.pdf\">Consentimiento para remisiones de vivienda<\/a>)<\/li>\n<\/ul>\n<p class=\"nitro-offscreen\">Download the forms above to make a request regarding your medical records. Questions? Call us at <a href=\"http:\/\/tel:+13128648200\">312-864-8200<\/a> \/ 711 TTD\/TTY.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>HIPAA &#038; Privacy Forms The Health Insurance Portability and Accountability Act (HIPAA) ensures your access to various health and human services, and it protects the privacy and security of your medical records and information. As a health plan, CountyCare regularly communicates with your provider about your care, and we follow strict guidelines outlined by HIPAA. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":10083,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"iawp_total_views":359,"footnotes":""},"class_list":["post-9496","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/pages\/9496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/comments?post=9496"}],"version-history":[{"count":0,"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/pages\/9496\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/media\/10083"}],"wp:attachment":[{"href":"https:\/\/countycare.com\/es\/wp-json\/wp\/v2\/media?parent=9496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}