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.
Q: What is Form DHCS6245A?
A: Form DHCS6245A is a request for an accounting of disclosures of protected health information by a parent, guardian, or legal representative.
Q: Who can use Form DHCS6245A?
A: This form can be used by parents, guardians, or legal representatives to request an accounting of disclosures of protected health information.
Q: What is the purpose of this form?
A: The purpose of this form is to allow individuals to request information about disclosures of their protected health information.
Q: Can I use this form if I am not a resident of Sacramento, California?
A: Yes, you can use this form regardless of your place of residence. However, you will need to contact the Sacramento Regional Office to obtain the form.
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.