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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DE-202
for the current year.
Form DE-202 Authorization to Disclose Protected Health Information to Ahcccs - Large Print - Arizona
What Is Form DE-202?
This is a legal form that was released by the Arizona Health Care Cost Containment System - 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 DE-202?A: Form DE-202 is an authorization form in Arizona that allows the disclosure of protected health information to Ahcccs.
Q: What does DE-202 authorize?A: DE-202 authorizes the release of protected health information to Ahcccs.
Q: What is Ahcccs?A: Ahcccs stands for Arizona Health Care Cost Containment System, which is Arizona's Medicaid program.
Q: Why would I need to fill out Form DE-202?A: You would need to fill out Form DE-202 if you want to allow the disclosure of your protected health information to Ahcccs.
Form Details:
- Released on November 1, 2022;
- The latest edition provided by the Arizona Health Care Cost Containment System;
- 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 DE-202 by clicking the link below or browse more documents and templates provided by the Arizona Health Care Cost Containment System.
Download Form DE-202 Authorization to Disclose Protected Health Information to Ahcccs - Large Print - Arizona
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