DCS Forms

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Download Number Form Name Effective Date
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
Microsoft Office document icon Download (57 KB) DCS-1044A-S Authorization for Disclosure of Protected Health Information (Spanish) 08/01/2014
Microsoft Office document icon Download (78 KB) DCS-1043A-S Individual's Request for Access to Protected health Information (Spanish) 08/01/2014
Microsoft Office document icon Download (39.5 KB) CSO-1006A Dentist's Certification of Medical Necessity 07/01/2014
PDF icon Download (61.56 KB) CRS App Span Application for Enrollment into AHCCCS CRS (Spanish) 09/01/2013
PDF icon Download (135.05 KB) Dental Matri Dental Matrix (CMDP) 01/01/2013