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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 IHS-912-1
for the current year.
Form IHS-912-1 Request for Restriction(S)
What Is Form IHS-912-1?
This is a legal form that was released by the U.S. Department of Health and Human Services - Indian Health Service on April 1, 2009 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form IHS-912-1?
A: Form IHS-912-1 is a request form for restrictions.
Q: What is the purpose of Form IHS-912-1?
A: The purpose of Form IHS-912-1 is to request restrictions on the disclosure of certain protected health information.
Q: Who can use Form IHS-912-1?
A: Form IHS-912-1 can be used by individuals who want to limit the use and disclosure of their health information.
Q: Is there a fee to submit Form IHS-912-1?
A: No, there is no fee to submit Form IHS-912-1.
Form Details:
- Released on April 1, 2009;
- The latest available edition released by the U.S. Department of Health and Human Services - Indian Health Service;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form IHS-912-1 by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Indian Health Service.
