PDF
Word
Form DDD-2173A Request for Amended / Correction of Protected Health Information (Phi) - Arizona
What Is Form DDD-2173A?
This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DDD-2173A?A: Form DDD-2173A is a request form for amended/correction of Protected Health Information (PHI) in Arizona.
Q: What is Protected Health Information (PHI)?A: Protected Health Information (PHI) refers to any individually identifiable health information that is created, received, or maintained by a health care provider or health plan.
Q: Who can use Form DDD-2173A?A: Any individual requesting an amendment or correction of their Protected Health Information (PHI) in Arizona can use Form DDD-2173A.
Q: What is the purpose of Form DDD-2173A?A: The purpose of Form DDD-2173A is to allow individuals to request an amendment or correction of their Protected Health Information (PHI) in Arizona.
Form Details:
- Released on February 1, 2023;
- The latest edition provided by the Arizona Department of Economic Security;
- 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 fillable version of Form DDD-2173A by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.
Download Form DDD-2173A Request for Amended / Correction of Protected Health Information (Phi) - Arizona
1
2
