Form DHCS6245 Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Personal Representative - California

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Form DHCS6245 Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Personal Representative - California

What Is Form DHCS6245?

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 Form DHCS6245?
A: Form DHCS6245 is a request for an accounting of disclosures of Protected Health Information (PHI) by a parent, guardian, or personal representative in the state of California.

Q: Who can use Form DHCS6245?
A: Form DHCS6245 can be used by a parent, guardian, or personal representative to request an accounting of disclosures of PHI.

Q: What is an accounting of disclosures?
A: An accounting of disclosures is a record of certain instances where your PHI has been shared with others.

Q: Why would someone request an accounting of disclosures?
A: Someone may request an accounting of disclosures to keep track of how their PHI is being shared and to ensure compliance with privacy regulations.

Q: Is there a fee for submitting Form DHCS6245?
A: No, there is no fee for submitting Form DHCS6245.

Q: Are there any special instructions for completing Form DHCS6245?
A: Yes, the form must be completed accurately and include all required information and authorizations.

Q: What happens after I submit Form DHCS6245?
A: After you submit Form DHCS6245, the entity holding your PHI will provide you with an accounting of disclosures within a certain timeframe as required by law.

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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;

Download a fillable version of Form DHCS6245 by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.

Download Form DHCS6245 Request for an Accounting of Disclosures of Protected Health Information by Parent, Guardian or Personal Representative - California

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