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Form NMH-3804 Authorization for the Use and Disclosure of Protected Health Information - Nevada
What Is Form NMH-3804?
This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the NMH-3804 form?A: The NMH-3804 form is the Authorization for the Use and Disclosure of Protected Health Information.
Q: Who uses the NMH-3804 form?A: The NMH-3804 form is used in Nevada.
Q: What is the purpose of the NMH-3804 form?A: The purpose of the NMH-3804 form is to authorize the use and disclosure of protected health information.
Q: What information is required on the NMH-3804 form?A: The NMH-3804 form requires information such as the individual's name, contact details, and details of the specific information to be disclosed.
Q: Can this form be used in other states?A: No, the NMH-3804 form is specific to Nevada.
Form Details:
- Released on November 1, 2015;
- The latest edition provided by the Nevada Department of Health and Human Services;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form NMH-3804 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
