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.
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.
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.
Form Details:
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.