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HIPAA Information

The following information is provided by DHS to comply with HIPAA, the Health Insurance Portability and Accountability Act.

pdf.gif DHS Notice of Privacy Practices for Protected Health Information
Describes how medical information may be used and disclosed and how to get access to this information


The forms below may be used by individuals to manage the use and disclosure of their protected health information.

pdf.gif Accounting of Disclosures Request Form
Allows an individual to request a record of when and to whom his/her records were released. 

pdf.gif Alternative Communication Request Form
Allows an individual to request that a means of communication, other than spoken English, be provided

pdf.gif  Authorization Form - Child/Adolescent Interagency Meeting 
Allows a parent/guardian or young adult to authorize the use and disclosure of protect health information among authorized participants in a child's interagency meeting. 

pdf.gif Health Information Amendment Request Form
Allows an individual to correct his/her health information record(s) that he/she feels is inaccurate   

pdf.gif Privacy Complaint Form
Allows an individual to file a formal complaint about the use and disclosure of his/her protected information

pdf.gif Restriction Request Form
Allows an individual to request restrictions on the use and disclosure of his/her protected information