Form DHCS6241A Request to Restrict Use and Disclosure of Protected Health Information by Parent, Guardian or Legal Representative (Sacramento Regional Office) - City of Sacramento, California

What Is Form DHCS6241A?

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

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;
• Fill out the form in our online filing application.

Download a fillable version of Form DHCS6241A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.