The following information is provided by DHS to comply with HIPAA, the Health Insurance Portability and Accountability Act.
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.
Accounting of Disclosures Request Form
Allows an individual to request a record of when and to whom his/her records were released.
Alternative Communication Request Form
Allows an individual to request that a means of communication, other than spoken English, be provided
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.
Health Information Amendment Request Form
Allows an individual to correct his/her health information record(s) that he/she feels is inaccurate
Privacy Complaint Form
Allows an individual to file a formal complaint about the use and disclosure of his/her protected information
Restriction Request Form
Allows an individual to request restrictions on the use and disclosure of his/her protected information