HIPAA Forms - SCRO

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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

Last modified on: 3/7/2008 9:38 AM