Compliance/HIPAA Forms
Authorization to Use and Disclose Health Information by DBH NON TPO 05-01-2024 FILLABLE
Authorization to Use and Disclose Health Information by DBH NON TPO 05-01-2024
Authorization to Use and Disclose Health Information by DBH TPO 05-01-2024 FILLABLE
Authorization to Use and Disclose Health Information by DBH TPO 05-01-2024
Authorization to Use and Disclose Health Information to be SENT TO DBH 05-01-2024 FILLABLE
Authorization to Use and Disclose Health Information to be SENT TO DBH 05-01-2024
Client Request for His or Her Own Record Fillable
Client Request for His or Her Own Record
Client Request to Amend Record SPANISH
Client Request to Amend Record
Client Restriction on the Uses and Disclosures of PHI for Treatment, Payment or Operations
PHI Disclosure to be Included in Client’s Accounting
Request for Accounting of PHI Disclosure by DBH
SPANISH Authorization to Use and Disclose Health Information by DBH NON TPO 11-26-2024
SPANISH Authorization to Use and Disclose Health Information by DBH TPO 11-26-2024
SPANISH Authorization to Use and Disclose Health Information to be SENT TO DBH 11-26-2024
SPANISH Client Request for His or Her Own Record Fillable
Credentialing