Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California

Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California

What Is Form DHCS6245A?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. The form may be used strictly within City and County of San Francisco. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DHCS6245A?
A: Form DHCS6245A is a Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative.

Q: What is the purpose of Form DHCS6245A?
A: The purpose of Form DHCS6245A is to request an accounting of disclosures of protected health information.

Q: Who can use Form DHCS6245A?
A: Parents, guardians or legal representatives can use Form DHCS6245A to request an accounting of disclosures of protected health information.

Q: What is the Northern California Regional Office/San Francisco?
A: The Northern California Regional Office/San Francisco is a specific location where you can access Form DHCS6245A.

Q: What is the City and County of San Francisco, California?
A: The City and County of San Francisco, California is the administrative entity responsible for providing Form DHCS6245A at the Northern California Regional Office/San Francisco.

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Form Details:

  • Released on November 1, 2007;
  • The latest edition provided by the California Department of Health Care Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DHCS6245A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.

Download Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California

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  • Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office/San Francisco) - City and County of San Francisco, California, Page 2

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  • Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California, Page 1
  • Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California, Page 2
  • Form DHCS6245A Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Legal Representative (Northern California Regional Office / San Francisco) - City and County of San Francisco, California, Page 3
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