​​​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 health plans covered by HIPAA.

General Forms

Medi-Cal Forms

Back to Privacy Office Home Page

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

Last modified date: 1/21/2020 11:11 AM