DCS Forms

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Download Number Form Name Effective Date
File Download (20.93 KB) DCS-1039A Notice of Privacy Practices 08/01/2014
Microsoft Office document icon Download (50 KB) DCS-1048A Request for Suspension of Accounting of Disclosures of Protected Health Information (PHI) 08/01/2014
File Download (22.93 KB) DCS-1039A-S Notice of Privacy Practices (Spanish) 08/01/2014
Microsoft Office document icon Download (58.5 KB) DCS-1048A-S Request for Suspension of Accounting of Disclosures of Protected Health Information (PHI) (Spanish) 08/01/2014
File Download (16.39 KB) DCS-1040A HIPAA Privacy Complaints 08/01/2014
Microsoft Office document icon Download (59 KB) DCS-1049A Accounting of Disclosures of Protected Health Information (PHI) 08/01/2014
File Download (16.69 KB) DCS-1040A-S HIPAA Privacy Complaints (Spanish) 08/01/2014
Microsoft Office document icon Download (62 KB) DCS-1049A-S Accounting of Disclosures of Protected Health Information (PHI) (Spanish) 08/01/2014
Microsoft Office document icon Download (40.5 KB) DCS-1041A HIPAA Privacy Complaint Confirmation of Receipt 08/01/2014
Microsoft Office document icon Download (60.5 KB) DCS-1050A Accounting Disclosure Tracking 08/01/2014

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