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Form DHCS6240A Request to Restrict Use and Disclosure of Protected Health Information (Northern California Regional Office / San Francisco) - City and County of San Francisco, California
What Is Form DHCS6240A?
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 and County of San Francisco. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DHCS6240A?
A: DHCS6240A is a form used to request the restriction of use and disclosure of protected health information.
Q: Who uses DHCS6240A?
A: DHCS6240A is used by the Northern California Regional Office/San Francisco of the City and County of San Francisco, California.
Q: What does DHCS6240A request?
A: DHCS6240A requests the restriction of the use and disclosure of an individual's protected health information.
Q: Why would I need to use DHCS6240A?
A: You may need to use DHCS6240A if you want to restrict the use and disclosure of your protected health information.
Q: Is DHCS6240A specific to the City and County of San Francisco?
A: Yes, DHCS6240A is specific to the Northern California Regional Office/San Francisco of the City and County of San Francisco, California.
Form Details:
- Released on November 1, 2007;
- The latest edition provided by the California Department of Health Care Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DHCS6240A by clicking the link below or browse more documents and templates provided by the California Department of Health Care Services.
Download Form DHCS6240A Request to Restrict Use and Disclosure of Protected Health Information (Northern California Regional Office / San Francisco) - City and County of San Francisco, California
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