Agencies
Services
HIPAA Privacy Forms Alphabetic Listing
- Authorization to Disclose All Kids/FamilyCare Information HFS 3806K (pdf)
- Authorization to Disclose All Kids/FamilyCare Information HFS 3806KS (pdf) (Spanish)
- Authorization to Disclose Health Information HFS 3806D (pdf)
- Authorization to Disclose Health Information HFS 3806DS(pdf) (Spanish)
- Complaint about Health Information Uses and Disclosures HFS 3806E (pdf)
- Complaint about Health Information Uses and Disclosures HFS 3806ES (pdf) (Spanish)
- Notice of Privacy Practice HFS 3806 (pdf)
- Notice of Privacy Practice HFS 3806S (pdf) (Spanish)
- Personal Representative Designation HFS3806F (pdf)
- Personal Representative Designation HFS 3806FS (pdf) (Spanish)
- Request for Access to Health Information HFS 3806L (pdf)
- Request for Access to Health Information HFS 3806LS (pdf) (Spanish)
- Request for an Accounting of Disclosures of Health Information HFS 3806G (pdf)
- Request for an Accounting of Disclosures of Health Information HFS 3806GS (pdf) (Spanish)
- Request to Amend Health Information HFS 3806H (pdf)
- Request to Amend Health Information HFS 3806HS (pdf) (Spanish)
- Request to Contact Client at a Different Address HFS 3806I (pdf)
- Request to Contact Client at a Different Address HFS 3806IS (pdf) (Spanish)
- Request to Restrict Uses and Disclosures of Health Information HFS 3806J (pdf)
- Request to Restrict Uses and Disclosures of Health Information HFS 3806JS (pdf) (Spanish)