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How do I cancel a HIPAA authorization when I no longer want to allow access to information on my account?


You must submit a HIPAA Revocation and/or Restriction of the Use and Disclosure of Individually Identifiable Health Information form by fax or mail  to the Judiciary Benefits Center.  You are stating that you no longer want to allow individuals (either all or those you name specifically) permission to speak, receive information and or act, on your behalf. Once received, your account will be noted.

For FSA account revocation, use this form - HIPAA Revocation and/or Restriction of the Use and Disclosure of Individually Identifiable Health Information - FSA.  For all non-FSA account  revocations, use this form - HIPAA Revocation and/or Restriction of the Use and Disclosure of Individually Identifiable Health Information - Non-FSA.

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