{"id":9840,"date":"2025-03-24T16:56:21","date_gmt":"2025-03-24T20:56:21","guid":{"rendered":"https:\/\/apshealth.com\/?page_id=9840"},"modified":"2025-11-24T15:47:13","modified_gmt":"2025-11-24T19:47:13","slug":"autorizacion-para-la-divulgacion-de-la-informacion","status":"publish","type":"page","link":"https:\/\/apshealth.com\/en\/asistencia-al-estudiante\/autorizacion-para-la-divulgacion-de-la-informacion\/","title":{"rendered":"Autorizaci\u00f3n para la Divulgaci\u00f3n de la Informaci\u00f3n | Programa de Asistencia al Estudiante"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"9840\" class=\"elementor elementor-9840\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-54b97dc e-con-full elementor-hidden-mobile e-flex e-con e-parent\" data-id=\"54b97dc\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element 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width=\"243\" height=\"40\" src=\"https:\/\/apshealth.com\/wp-content\/uploads\/2024\/09\/OptiMind.png\" class=\"attachment-large size-large wp-image-8306\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-03fbbc2 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"03fbbc2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.23.0 - 05-08-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading 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height=\"34\" fill=\"white\"><\/rect><\/clippath><\/defs><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ded835d elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"ded835d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Comprehensive Support for Students.<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-70a48c2 e-flex e-con-boxed e-con e-parent\" data-id=\"70a48c2\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cd3a5c0 elementor-widget elementor-widget-heading\" data-id=\"cd3a5c0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Autorizaci\u00f3n para la Divulgaci\u00f3n de la Informaci\u00f3n<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a02ecad elementor-widget elementor-widget-heading\" data-id=\"a02ecad\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Programa de Asistencia al Estudiante<\/h3>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-74af2d7 elementor-widget elementor-widget-heading\" data-id=\"74af2d7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Completar 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class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_e1dfb06 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Estudiante\" data-previousbutton=\"\" data-nextbutton=\"Siguiente\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-full_name elementor-col-100\">\n\t\t\t\t\t<p class=\"form-text\">\nYo, (estudiante, tutor legal o familiar) ______________________________________________, y residente de ______________________________________, certifico que he sido orientado\/a sobre el Programa de Asistencia al Estudiante de <strong>APSOptimind<\/strong> enti\u00e9ndase sus normas, procedimientos y beneficios, por tanto:\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-consent elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Consiento\" id=\"form-field-consent-0\" name=\"form_fields[consent]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-consent-0\">Consiento<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No consiento\" id=\"form-field-consent-1\" name=\"form_fields[consent]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-consent-1\">No consiento<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_d6da60c elementor-col-100\">\n\t\t\t\t\t<ul class=\"form-text\" style=\"padding-left: 20px;\">\n<li>Asistencia en la coordinaci\u00f3n de los servicios<\/li>\n<li>Recibir servicios solicitados<\/li>\n<li>Visitas de seguimiento con el\/la proveedora de servicios (si aplica)<\/li>\n<\/ul>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_62f9453 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Coordinador\" data-previousbutton=\"Anterior\" data-nextbutton=\"Siguiente\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c972597 elementor-col-100\">\n\t\t\t\t\t<p class=\"form-text\">\nA su vez, autorizo al Coordinador\/a del Programa de Asistencia al Estudiante de <strong>APSOptimind<\/strong> a divulgar informaci\u00f3n relacionada a los servicios solicitados. Dicha informaci\u00f3n ser\u00e1 utilizada a los efectos de trabajar con mi tratamiento. El\/la Coordinador\/a del  Programa de Asistencia al Estudiante de <strong>APSOptimind<\/strong> tiene la autorizaci\u00f3n para divulgar\/recibir la siguiente informaci\u00f3n:\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-information_authorized elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Informaci\u00f3n Personal\" id=\"form-field-information_authorized-0\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-0\">Informaci\u00f3n Personal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Diagn\u00f3stico, s\u00edntomas\" id=\"form-field-information_authorized-1\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-1\">Diagn\u00f3stico, s\u00edntomas<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Citas de Seguimiento\" id=\"form-field-information_authorized-2\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-2\">Citas de Seguimiento<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Evaluaci\u00f3n Inicial\" id=\"form-field-information_authorized-3\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-3\">Evaluaci\u00f3n Inicial<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Plan de Tratamiento\" id=\"form-field-information_authorized-4\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-4\">Plan de Tratamiento<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Recomendaciones cl\u00ednicas\" id=\"form-field-information_authorized-5\" name=\"form_fields[information_authorized][]\"> <label for=\"form-field-information_authorized-5\">Recomendaciones cl\u00ednicas<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_839026b elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Autorizaci\u00f3n\" data-previousbutton=\"Anterior\" data-nextbutton=\"Enviar\" data-iconurl=\"\" data-iconlibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_36470cf elementor-col-100\">\n\t\t\t\t\t<p class=\"form-text\">Tambi\u00e9n entiendo que se me ha explicado a cabalidad que la informaci\u00f3n a divulgar es estrictamente confidencial. Iniciales:\nDicha informaci\u00f3n ser\u00e1 exclusivamente utilizada por las personas indicadas en el punto anterior. Iniciales:<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-refered_person_name elementor-col-40 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-refered_person_name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNombre de la persona referida, tutor legal o familiar\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[refered_person_name]\" id=\"form-field-refered_person_name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-refered_person_sign elementor-col-40 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-refered_person_sign\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirma persona referida, tutor legal o familiar\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[refered_person_sign]\" id=\"form-field-refered_person_sign\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" aria-required=\"true\" data-maxsize=\"10\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-date elementor-col-40 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-date\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[date]\" id=\"form-field-date\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a5fae5f elementor-col-100\">\n\t\t\t\t\t<div class=\"file-input-styled\" id=\"refered_person_sign_styled\">\n    <div class=\"upload-options\">\n        <svg class=\"upload-icon\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"24\" height=\"24\" viewbox=\"0 0 24 24\" fill=\"none\">\n          <path d=\"M5 20H19V18H5V20ZM5 10H9V16H15V10H19L12 3L5 10Z\" fill=\"#00A9CE\"\/>\n        <\/svg>\n        <p>Subir firma<\/p><span>(formatos png, jpg, jpge, pdf)<\/span>\n    <\/div>\n\n    \n    <div class=\"uploaded-options\">\n        <p id=\"file_uploaded_info\"><\/p>\n        <button type=\"button\" id=\"remove_file\">\n            <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" fill=\"none\" viewbox=\"0 0 24 24\" stroke-width=\"1.5\" stroke=\"currentColor\" class=\"size-6\" style=\"            width: 20px;            color: #00A9CE;            \">\n            <path stroke-linecap=\"round\" stroke-linejoin=\"round\" d=\"m14.74 9-.346 9m-4.788 0L9.26 9m9.968-3.21c.342.052.682.107 1.022.166m-1.022-.165L18.16 19.673a2.25 2.25 0 0 1-2.244 2.077H8.084a2.25 2.25 0 0 1-2.244-2.077L4.772 5.79m14.456 0a48.108 48.108 0 0 0-3.478-.397m-12 .562c.34-.059.68-.114 1.022-.165m0 0a48.11 48.11 0 0 1 3.478-.397m7.5 0v-.916c0-1.18-.91-2.164-2.09-2.201a51.964 51.964 0 0 0-3.32 0c-1.18.037-2.09 1.022-2.09 2.201v.916m7.5 0a48.667 48.667 0 0 0-7.5 0\"><\/path>\n            <\/svg>\n        <\/button>\n    <\/div>\n<\/div>\n    \n<script>\ndocument.addEventListener(\"DOMContentLoaded\", function () {\n    let movableDiv = document.getElementById(\"refered_person_sign_styled\");\n    let container = document.querySelector(\".elementor-field-group-refered_person_sign\");\n    let fileInput = document.getElementById(\"form-field-refered_person_sign\");\n    let uploadOptions = document.querySelector(\".upload-options\");\n    let uploadedOptions = document.querySelector(\".uploaded-options\");\n    let fileNameDisplay = document.getElementById(\"file_uploaded_info\");\n    let removeFileButton = document.getElementById(\"remove_file\");\n    \n    container.appendChild(movableDiv);\n    \n    movableDiv.addEventListener(\"click\", function() {\n        fileInput.click();\n    });\n\n    fileInput.addEventListener(\"change\", function () {\n        if (fileInput.files.length > 0) {\n            fileNameDisplay.innerHTML = fileInput.files[0].name;\n            uploadedOptions.style.display = \"flex\";\n            uploadOptions.style.display = \"none\";\n        }\n    });\n\n    removeFileButton.addEventListener(\"click\", function (event) {\n        event.preventDefault();\n        event.stopPropagation();\n        fileInput.value = \"\";\n        fileNameDisplay.textContent = \"\";\n        uploadedOptions.style.display = \"none\";\n        uploadOptions.style.display = \"flex\";\n    });\n    \n});\n<\/script>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Apoyo Integral para Estudiantes. Apoyo Integral para Estudiantes. Autorizaci\u00f3n para la Divulgaci\u00f3n de la Informaci\u00f3n Programa de Asistencia al Estudiante Completar formulario<\/p>","protected":false},"author":1,"featured_media":0,"parent":2330,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-9840","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/pages\/9840"}],"collection":[{"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/comments?post=9840"}],"version-history":[{"count":301,"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/pages\/9840\/revisions"}],"predecessor-version":[{"id":11839,"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/pages\/9840\/revisions\/11839"}],"up":[{"embeddable":true,"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/pages\/2330"}],"wp:attachment":[{"href":"https:\/\/apshealth.com\/en\/wp-json\/wp\/v2\/media?parent=9840"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}