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REQUEST FOR PROTECTED HEALTH INFORMATION UNDER HIPAASalt Lake County Jail 3415 South 900 West Salt Lake City, UT 84119 3854688600 FAX 3854688722 or 8012668931 EMail: ADCMedicalRecords@slco.orgThe

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What is request for protected health?

A request for protected health refers to a formal application made by an individual to access, amend, or obtain copies of their protected health information (PHI), which is kept by healthcare providers or organizations.

Who is required to file request for protected health?

Individuals who wish to access their protected health information or that of a dependent typically need to file this request. This includes patients, their legal guardians, and authorized representatives.

How to fill out request for protected health?

To fill out a request for protected health, individuals must provide personal information such as their name, date of birth, and contact details, specify the information being requested, indicate the purpose of the request, and may need to sign the form.

What is the purpose of request for protected health?

The purpose of a request for protected health is to enable individuals to obtain access to their medical records, ensure the accuracy of information, and facilitate communication regarding their healthcare.

What information must be reported on request for protected health?

The request must typically include the individual's full name, date of birth, the specific health information being requested, the date range of the requested information, the purpose of the request, and the individual's signature.

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