Form DE-202 Authorization to Disclose Protected Health Information to Ahcccs - Large Print - Arizona

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form DE-202 for the current year.

Form DE-202 Authorization to Disclose Protected Health Information to Ahcccs - Large Print - Arizona

What Is Form DE-202?

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.

Form Details:

  • Released on July 1, 2021;
  • The latest edition provided by the Arizona Health Care Cost Containment System;
  • 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 DE-202 by clicking the link below or browse more documents and templates provided by the Arizona Health Care Cost Containment System.

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Download Form DE-202 Authorization to Disclose Protected Health Information to Ahcccs - Large Print - Arizona

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