Form DHCS6240A Request to Restrict Use and Disclosure of Protected Health Information - Genetically Handicapped Persons Program - California

What Is Form DHCS6240A?

This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DHCS6240A?A: DHCS6240A is a form used for requesting to restrict the use and disclosure of protected health information for the Genetically Handicapped Persons Program (GHPP) in California.

Q: Who can use the DHCS6240A form?A: The DHCS6240A form is specifically for individuals enrolled in the Genetically Handicapped Persons Program (GHPP) in California.

Q: What is the purpose of the DHCS6240A form?A: The purpose of the DHCS6240A form is to allow GHPP enrollees to request restrictions on how their protected health information is used and disclosed.

Q: What information is required on the DHCS6240A form?A: The DHCS6240A form requires information such as the enrollee's name, GHPP identification number, specific restrictions being requested, and the enrollee's signature.

Q: Are there any fees for submitting the DHCS6240A form?A: No, there are no fees for submitting the DHCS6240A form.

Q: What happens after I submit the DHCS6240A form?A: After you submit the DHCS6240A form, the GHPP will review your request and notify you of their decision regarding the requested restrictions on the use and disclosure of your protected health information.