Form ODM03398 Request for Accounting for Disclosure of Protected Health Information - Ohio

Form ODM03398 Request for Accounting for Disclosure of Protected Health Information - Ohio

What Is Form ODM03398?

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

FAQ

Q: What is Form ODM03398?
A: Form ODM03398 is a request for an accounting of disclosures of protected health information (PHI) made by a covered entity in Ohio.

Q: Who should use Form ODM03398?
A: Form ODM03398 should be used by individuals in Ohio who want to request an accounting of disclosures of their protected health information by a covered entity.

Q: What is an accounting of disclosures?
A: An accounting of disclosures is a record of instances where a covered entity has disclosed an individual's protected health information to third parties.

Q: Why would someone request an accounting of disclosures?
A: Someone may request an accounting of disclosures to have a better understanding of who has accessed their protected health information and for what purpose.

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Form Details:

  • Released on June 1, 2021;
  • The latest edition provided by the Ohio Department of Medicaid;
  • 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 ODM03398 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.

Download Form ODM03398 Request for Accounting for Disclosure of Protected Health Information - Ohio

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  • Form ODM03398 Request for Accounting for Disclosure of Protected Health Information - Ohio, Page 1
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