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Form DCH-1183 Authorization to Disclose Protected Health Information - Michigan
What Is Form DCH-1183?
This is a legal form that was released by the Michigan Department of Health and Human Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DCH-1183?
A: Form DCH-1183 is a document used in Michigan to authorize the disclosure of protected health information.
Q: Who needs to fill out Form DCH-1183?
A: Patients or their authorized representatives may need to fill out Form DCH-1183.
Q: What is the purpose of Form DCH-1183?
A: The purpose of Form DCH-1183 is to give consent for the disclosure of protected health information to a specified individual or entity.
Q: What information is required on Form DCH-1183?
A: Form DCH-1183 requires the patient's or representative's personal information, the name of the individual or entity receiving the information, and the purpose of the disclosure.
Form Details:
- Released on May 1, 2015;
- The latest edition provided by the Michigan Department of Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form DCH-1183 by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.
Download Form DCH-1183 Authorization to Disclose Protected Health Information - Michigan
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