Get the free Your Patient Privacy Rights - California Department of Justice
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Confidential Patient Information
CA W & I Code, Section 5328COUNTY OF ORANGE, CALIFORNIA
HEALTH CARE AGENCY
BEHAVIORAL HEALTH SERVICESTREATMENT AUTHORIZATION REQUEST
FOR PAYMENT OF PRESCRIPTION,
CONSULTATION,
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How to fill out your patient privacy rights
How to fill out your patient privacy rights
01
Read and understand the healthcare provider's privacy policy.
02
Fill out the necessary forms with your personal information.
03
Specify who can access your medical records and for what purposes.
04
Review and sign the document to acknowledge your understanding and agreement to the privacy rights.
Who needs your patient privacy rights?
01
Anyone receiving healthcare services at a medical facility or from a healthcare provider.
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What is your patient privacy rights?
Your patient privacy rights include the right to control your own medical information and to keep it confidential.
Who is required to file your patient privacy rights?
Your healthcare provider or medical facility is required to file your patient privacy rights.
How to fill out your patient privacy rights?
You can fill out your patient privacy rights by completing the necessary forms provided by your healthcare provider or facility.
What is the purpose of your patient privacy rights?
The purpose of your patient privacy rights is to protect your sensitive medical information and ensure that it is only shared with authorized individuals.
What information must be reported on your patient privacy rights?
Your patient privacy rights should include details about who can access your medical records and under what circumstances they can be shared.
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