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Revocation of HIPAA Authorization under HIPAA Rule 164.508Return completed form to Privacy Officer, ___ (name of privacy officer), ___ (address of privacy officer):Please be advised that I, the undersigned,
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The return completed form should be submitted to the designated office or department specified on the form.
Individuals or entities who meet the criteria outlined in the instructions or regulations associated with the form are required to file it.
To fill out the return completed form, complete all required fields accurately, ensure that the information is clear, and double-check for any errors before submitting.
The purpose of the return completed form is to provide necessary information for processing, compliance, or record-keeping as required by regulations.
The information that must be reported typically includes personal identification details, financial information, and any other relevant data as specified in the form's instructions.
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