HIPAA Forms for Requesting Access to Protected Health Information - Southern California Regional Office

• Confidential Communication Request - DHS 6235a
• Request to Access Protected Health Information - DHS 6236a
• Request to Access Protected Health Information by Parent, Guardian or Legal Representative - DHS 6237a
• Request to Amend Protected Health Information - DHS 6238a
• Request to Amend Protected Health Information by Parent, Guardian or Legal Representative - DHS 6239a
• Request to Restrict Use and Disclosure of Protected Health Information - DHS 6240a
• Request to Restrict Use and Disclosure of Protected Health Information by Parent, Guardian or Legal Representative - DHS 6241a
• Request for an Accounting of Disclosures of Protected Health Information - DHS 6244a
• Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative - DHS 6245a
• Authorization for Release of Protected Health Information - DHS 6247