When Your Authorization is Required
- Purpose of this Notice
- Who will Follow this Notice
- BCM's Commitment
- Understanding your Health Record
- How we may Use and Disclose Information about You
- When Your Authorization is Required
- Special Protections for Alcohol and Drug Abuse Information
- Your Rights
- Changes to this Notice
- For more Information, Requests Related to your Rights, or to Report a Problem
- Forms
Uses or disclosures of your PHI for other purposes or activities not listed above will be made only with your written authorization (permission). If you provide us authorization to use or disclose your PHI, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission. However, we are unable to take back any disclosures we have already made with your permission.
An authorization form is available from your health care provider or by calling the BCM Compliance Office. See compliance contact information.