​​​​Privacy Forms

The following privacy forms help individuals access their protected health information and exercise other privacy rights. T​​hese are the Health Information Portability and accountability Act (HIPAA) forms used by DHCS.

Access to Protected Health Information

To request these forms in Spanish, please email your request to DHCS at privacyofficer2@dhcs.ca.gov.​​

Other Privacy Forms

Back to Privacy Office Home Page

Links on this page are documents in Adobe Acrobat Portable Document Format (PDF).

Last modified date: 8/26/2022 11:24 AM