Form DHCS6240 Request to Restrict Use and Disclosure of Protected Health Information - California

What Is Form DHCS6240?

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 the Form DHCS6240?A: Form DHCS6240 is a request form used in California to restrict the use and disclosure of Protected Health Information (PHI).

Q: Why would someone use Form DHCS6240?A: Someone would use Form DHCS6240 to restrict who can access and share their PHI in California.

Q: Who can use Form DHCS6240?A: Any individual who wants to restrict the use and disclosure of their PHI in California can use Form DHCS6240.

Q: What information is required on Form DHCS6240?A: Form DHCS6240 requires information such as the individual's name, address, date of birth, and a description of the restrictions requested.

Q: How long does the restriction on PHI last?A: The restriction on PHI requested through Form DHCS6240 is generally permanent unless the individual revokes it.

Q: Can the restriction on PHI be lifted?A: Yes, the individual can lift the restriction on their PHI at any time by submitting a written request to do so.