This is a legal form that was released by the California Department of Health Care Services - a government authority operating within California. The form may be used strictly within City of Los Angeles. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is DHCS6235A?
A: DHCS6235A is a form used to request confidential communication in the Southern California Regional Office of the City of Los Angeles, California.
Q: What is confidential communication?
A: Confidential communication is a request to keep your personal health information private and secure.
Q: Why would I need to request confidential communication?
A: You may need to request confidential communication to protect your privacy and ensure that your health information is not shared with certain individuals or entities.
Q: How can I obtain DHCS6235A form?
A: You can obtain the DHCS6235A form by contacting the Southern California Regional Office of the City of Los Angeles, California.
Q: Who can submit the DHCS6235A form?
A: The patient or their authorized representative can submit the DHCS6235A form.
Q: Is there a fee to submit the DHCS6235A form?
A: There is typically no fee to submit the DHCS6235A form.
Q: What happens once I submit the DHCS6235A form?
A: Once you submit the DHCS6235A form, your request for confidential communication will be reviewed and processed by the Southern California Regional Office of the City of Los Angeles, California.
Form Details:
Download a fillable version of Form DHCS6235A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.