DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C.

DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C.

What Is DBH-HIPAA Form 3?

This is a legal form that was released by the Washington DC Department of Behavioral Health - a government authority operating within Washington, D.C.. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DBH-HIPAA Form 3?A: DBH-HIPAA Form 3 is an authorization form used in Washington, D.C. to give permission for the use or disclosure of protected health information.

Q: What is protected health information?A: Protected health information refers to any information about a person's health or healthcare that is protected under the Health Insurance Portability and Accountability Act (HIPAA).

Q: Who uses DBH-HIPAA Form 3?A: DBH-HIPAA Form 3 is used by individuals in Washington, D.C. who want to authorize the use or disclosure of their protected health information.

Q: What is the purpose of DBH-HIPAA Form 3?A: The purpose of DBH-HIPAA Form 3 is to allow individuals to give consent for the use or disclosure of their protected health information by the District of Columbia Department of Behavioral Health (DBH).

ADVERTISEMENT

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Washington DC Department of Behavioral Health;
  • 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 DBH-HIPAA Form 3 by clicking the link below or browse more documents and templates provided by the Washington DC Department of Behavioral Health.

Download DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C.

4.8 of 5 (26 votes)
  • DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C.

    1

  • DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C., Page 2

    2

  • DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C., Page 1
  • DBH-HIPAA Form 3 Authorization to Use or Disclose Protected Health Information - Washington, D.C., Page 2
Prev 1 2 Next
ADVERTISEMENT

Related Documents