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Document used for application, enrollment, registration or eligibility determination purposes.
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| Effective Date | Title - Owner - Description |
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09/15/2008 |
Access to Records Request -
Office of Improvement & Integrity,
Privacy Officer -
Complete the Access to Records Request form to view or receive copies of records containing individually identifiable health information. |
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09/15/2008 |
Accounting of Disclosures Request -
Office of Improvement & Integrity,
Privacy Officer -
Complete Accounting of Disclosures form to request instances where your protected health information has been used or disclosed by DHHS. |
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09/15/2008 |
Amendment to Records Request -
Office of Improvement & Integrity,
Privacy Officer -
Complete the Amendment Request Form to request changes to records containing individually identifiable health information. |
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09/15/2008 |
Authorization Form, General Manual Form 509b
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Office of Improvement & Integrity,
Privacy Officer -
Complete the Authorization Form to authorize the release of individually identifiable health information (Protected Health Information) to third parties. |
