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8/31/15 0I REVOCATION OF CONFIDENTIAL COMMUNICATION This form is for subscribers and members covered by the GHA Health, GHA Connection Dental Federal, CONNECTION Dental Plus plans and/or Connection
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Point by point on how to fill out revocation of confidential communication:

01
Obtain the appropriate revocation form: Start by locating the specific revocation of confidential communication form that is required by the governing entity. This form can usually be found on their official website or obtained from their office.
02
Fill in the personal details: Begin by providing your personal information on the form, such as your full name, address, contact number, and any other required identification details.
03
Specify the relevant communication: Indicate the specific communication or communications that you wish to revoke. This could include naming individuals, organizations, or specific types of communication channels.
04
Add the date and signature: Sign and date the revocation form to authenticate and finalize the document.
05
Save a copy for your records: Make sure to keep a copy of the completed and signed revocation form for your own records.
06
Submit the form: Based on the instructions provided on the form or by the governing entity, submit the revocation form to the appropriate recipient or office.

Who needs revocation of confidential communication?

01
Individuals who have previously granted someone access to their confidential information, and now wish to revoke that permission.
02
Businesses or organizations that have previously allowed an outside party access to their confidential documents or data, and now want to terminate that access.
03
Patients who have given healthcare providers permission to share their medical information with certain individuals or entities, but now want to restrict or revoke that access.
04
Any individual or entity that wants to ensure the confidentiality of their communication by explicitly stating who does not have permission to access it.
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Revocation of confidential communication is the process of withdrawing previous consent to keep communication confidential.
The individual who initially gave consent for communication to be confidential is required to file the revocation.
The revocation can be filled out by following the instructions provided by the organization or entity handling the communication.
The purpose of revocation is to allow the individual to change their mind about keeping the communication confidential.
The revocation should include basic information such as the individual's name, contact information, and the specific communication being revoked.
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Relevant keywords

GEHA GEHAs PHI11 R6 precertification REVOCATION ATTN subscribers Subscriber revoke outlined requiring documentation INVALID

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