Form NMH-3804 Authorization for the Use and Disclosure of Protected Health Information - Nevada

Form NMH-3804 Authorization for the Use and Disclosure of Protected Health Information - Nevada

What Is Form NMH-3804?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the NMH-3804 form?
A: The NMH-3804 form is the Authorization for the Use and Disclosure of Protected Health Information.

Q: Who uses the NMH-3804 form?
A: The NMH-3804 form is used in Nevada.

Q: What is the purpose of the NMH-3804 form?
A: The purpose of the NMH-3804 form is to authorize the use and disclosure of protected health information.

Q: What information is required on the NMH-3804 form?
A: The NMH-3804 form requires information such as the individual's name, contact details, and details of the specific information to be disclosed.

Q: Can this form be used in other states?
A: No, the NMH-3804 form is specific to Nevada.

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Form Details:

  • Released on November 1, 2015;
  • The latest edition provided by the Nevada Department of Health and Human Services;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NMH-3804 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

Download Form NMH-3804 Authorization for the Use and Disclosure of Protected Health Information - Nevada

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  • Form NMH-3804 Authorization for the Use and Disclosure of Protected Health Information - Nevada, Page 1
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