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Form DHS-4000 Authorization to Disclose Health Information - Arkansas
What Is Form DHS-4000?
This is a legal form that was released by the Arkansas Department of Human Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DHS-4000 form?
A: DHS-4000 is an Authorization to Disclose Health Information form.
Q: What is the purpose of the DHS-4000 form?
A: The purpose of the DHS-4000 form is to authorize the disclosure of health information.
Q: Who uses the DHS-4000 form?
A: The DHS-4000 form is used by individuals in Arkansas.
Q: What information is disclosed with the DHS-4000 form?
A: The DHS-4000 form authorizes the disclosure of health information.
Q: Is the DHS-4000 form specific to Arkansas?
A: Yes, the DHS-4000 form is specific to Arkansas.
Form Details:
- Released on November 1, 2005;
- The latest edition provided by the Arkansas Department of 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 DHS-4000 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Human Services.
Download Form DHS-4000 Authorization to Disclose Health Information - Arkansas
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