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 - Arizona

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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.

FAQ

Q: What is Form DE-202?
A: Form DE-202 is a document that authorizes the disclosure of protected health information to Ahcccs - Arizona.

Q: What is Ahcccs?
A: Ahcccs stands for Arizona Health Care Cost Containment System. It is a program that provides health insurance coverage to eligible individuals in Arizona.

Q: Who can use Form DE-202?
A: Form DE-202 can be used by individuals who want to authorize the disclosure of their protected health information to Ahcccs.

Q: Why is Form DE-202 needed?
A: Form DE-202 is needed to ensure that Ahcccs has permission to access an individual's protected health information for the purpose of providing and coordinating healthcare services.

Q: Are there any fees associated with Form DE-202?
A: No, there are no fees associated with Form DE-202.

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.