Form DE-202 LARGE PRINT Authorization to Disclose Protected Health Information to Ahcccs - Arizona

What Is Form DE-202 LARGE PRINT?

This is a legal form that was released by the Arizona Health Care Cost Containment System - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is form DE-202 LARGE PRINT?
A: Form DE-202 LARGE PRINT is an authorization form used to disclose protected health information to Ahcccs in Arizona.

Q: Who can use form DE-202 LARGE PRINT?
A: Anyone who needs to authorize the disclosure of their protected health information to Ahcccs in Arizona can use this form.

Q: What is Ahcccs?
A: Ahcccs (Arizona Health Care Cost Containment System) is Arizona's Medicaid program that provides health insurance to low-income individuals and families.

Q: Why would someone need to use this form?
A: This form is used when individuals want to give permission for their protected health information to be shared with Ahcccs for purposes such as medical coverage, treatment, or payment.

Q: Is this form specific to Arizona?
A: Yes, form DE-202 LARGE PRINT is specific to Arizona and is used to authorize the disclosure of protected health information to Ahcccs in the state.

Q: What should be included in the form?
A: The form should include the individual's personal information, details about the information to be disclosed, the purpose of disclosure, and the duration of the authorization.