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.
Q: What is DHCS6239A?
A: DHCS6239A is a form used to request to amend protected health information by parent, guardian or legal representative.
Q: Who can use DHCS6239A?
A: DHCS6239A can be used by parents, guardians or legal representatives.
Q: What does DHCS6239A form do?
A: DHCS6239A form is used to request amendments to protected health information.
Q: Is DHCS6239A specific to a certain region?
A: Yes, DHCS6239A is specific to the Northern California Regional Office/San Francisco of the City and County of San Francisco, California.
Download a fillable version of Form DHCS6239A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.