DCS Forms

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Download Number Form Name Effective Date
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
Microsoft Office document icon Download (43.5 KB) DCS-1041A-S HIPAA Privacy Complaint Confirmation of Receipt (Spanish) 08/01/2014
Microsoft Office document icon Download (67 KB) DCS-1050A-S Accounting Disclosure Tracking (Spanish) 08/01/2014
Microsoft Office document icon Download (40.5 KB) DCS-1042A Response to HIPAA Privacy Complaint 08/01/2014
Microsoft Office document icon Download (50.5 KB) DCS-1051A Request for an Accounting of Disclosures of Protected Health 08/01/2014
Microsoft Office document icon Download (44 KB) DCS-1042A-S Response to HIPAA Privacy Complaint (Spanish) 08/01/2014
Microsoft Office document icon Download (52.5 KB) DCS-1051A-S Request for an Accounting of Disclosures of Protected Health (Spanish) 08/01/2014
Microsoft Office document icon Download (49 KB) DCS-1044A Authorization for Disclosure of Protected Health Information 08/01/2014

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