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PATIENT OPT-OUT OF FUNDRAISING EFFORTS
A communication to an individual that is made by a covered entity, an institutionally related foundation, or a business associate
on behalf of the covered entity
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How to fill out patient opt-out of fundraising

How to fill out patient opt-out of fundraising:
01
Locate the patient opt-out form, which is usually available at the healthcare provider's office or on their website.
02
Read the instructions and guidelines provided on the form to understand the process and requirements for opting out of fundraising.
03
Fill out the patient information section accurately, providing your full name, contact information, and any other details as requested.
04
Indicate your preference for opting out of fundraising by checking the appropriate box or selecting the designated option.
05
Carefully review the form for completeness and ensure that all required fields are filled out.
06
Consider including any additional information or comments that may assist the healthcare provider in processing your opt-out request.
07
Sign and date the form to validate your submission.
08
Submit the completed opt-out form to the relevant department or personnel at the healthcare provider's office, following their specified submission process.
09
Keep a copy of the filled out form for your records.
Who needs patient opt-out of fundraising:
01
Patients who prefer not to be contacted or involved in any fundraising activities carried out by their healthcare provider.
02
Individuals who do not wish to receive fundraising solicitations or information related to the healthcare provider's fundraising campaigns or events.
03
Those who have personal or ethical reasons for opting out of healthcare fundraising and prefer to focus solely on their medical treatment and care.
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What is patient opt-out of fundraising?
Patient opt-out of fundraising is when a patient requests to not have their information used for fundraising purposes.
Who is required to file patient opt-out of fundraising?
Healthcare organizations and institutions are required to file patient opt-out of fundraising requests.
How to fill out patient opt-out of fundraising?
Patient opt-out of fundraising can be filled out by submitting a written request to the healthcare organization or institution.
What is the purpose of patient opt-out of fundraising?
The purpose of patient opt-out of fundraising is to respect the patient's wishes and protect their privacy.
What information must be reported on patient opt-out of fundraising?
Patient's name, contact information, and request to opt-out of fundraising must be reported.
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