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Arizona Department of Child Safety
Phone: Child Abuse Hotline 1-888-767-2445
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Number | Form Name | Effective Date | ||
---|---|---|---|---|
Download DCS-1041A | DCS-1041A | HIPAA Privacy Complaint Confirmation of Receipt | 08/01/2014 | |
Download DCS-1050A | DCS-1050A | Accounting Disclosure Tracking | 08/01/2014 | |
Download DCS-1041A-S | DCS-1041A-S | HIPAA Privacy Complaint Confirmation of Receipt (Spanish) | 08/01/2014 | |
Download DCS-1050A-S | DCS-1050A-S | Accounting Disclosure Tracking (Spanish) | 08/01/2014 | |
Download DCS-1042A | DCS-1042A | Response to HIPAA Privacy Complaint | 08/01/2014 | |
Download DCS-1051A | DCS-1051A | Request for an Accounting of Disclosures of Protected Health | 08/01/2014 | |
Download DCS-1042A-S | DCS-1042A-S | Response to HIPAA Privacy Complaint (Spanish) | 08/01/2014 | |
Download DCS-1051A-S | DCS-1051A-S | Request for an Accounting of Disclosures of Protected Health (Spanish) | 08/01/2014 | |
Download DCS-1044A | DCS-1044A | Authorization for Disclosure of Protected Health Information | 08/01/2014 | |
Download DCS-1044A-S | DCS-1044A-S | Authorization for Disclosure of Protected Health Information (Spanish) | 08/01/2014 |
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