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Revocation of Authorization to Use and/or Disclose Health Information want to cancel, or revoke, the permission I gave to PA Health & Wellness to use my health information for a particular purpose
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Anyone who wishes to revoke or cancel their pahipaa consent or authorization may need the pahipaa revocation accessible PDF.
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Individuals who have previously given their consent for the release of their protected health information (PHI) under pahipaa may need to fill out this form to revoke that consent.
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