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

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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.

FAQ

Q: What is Form DE-202?
A: Form DE-202 is an authorization form in Arizona that allows the disclosure of protected health information to Ahcccs.

Q: What does DE-202 authorize?
A: DE-202 authorizes the release of protected health information to Ahcccs.

Q: What is Ahcccs?
A: Ahcccs stands for Arizona Health Care Cost Containment System, which is Arizona's Medicaid program.

Q: Why would I need to fill out Form DE-202?
A: You would need to fill out Form DE-202 if you want to allow the disclosure of your protected health information to Ahcccs.

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Form Details:

  • Released on November 1, 2022;
  • 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.

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

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