Form DHCS6237A Request to Access Protected Health Information by Parent, Guardian or Legal Representative (Southern California Regional Office) - City of Los Angeles, California

What Is Form DHCS6237A?

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 of Los Angeles. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is form DHCS6237A?A: Form DHCS6237A is a request form used to access protected health information

Q: Who can use form DHCS6237A?A: Parents, guardians, or legal representatives can use form DHCS6237A to request access to protected health information

Q: Which office is the form specific to?A: The form DHCS6237A is specific to the Southern California Regional Office in the City of Los Angeles, California

Q: What is the purpose of this form?A: The purpose of form DHCS6237A is to request access to protected health information for a minor or incapacitated adult under the care of the parent, guardian, or legal representative

Q: What information is required on this form?A: The form DHCS6237A requires information such as the name of the minor or incapacitated adult, the name of the parent, guardian, or legal representative, and a signature