DCS Forms
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| Download | Number | Form Name | Effective Date | |
|---|---|---|---|---|
 Download (60.5 KB) |
DCS-1050A | Accounting Disclosure Tracking | 08/01/2014 | |
|
Download (43.5 KB) |
DCS-1041A-S | HIPAA Privacy Complaint Confirmation of Receipt (Spanish) | 08/01/2014 | |
|
Download (67 KB) |
DCS-1050A-S | Accounting Disclosure Tracking (Spanish) | 08/01/2014 | |
|
Download (40.5 KB) |
DCS-1042A | Response to HIPAA Privacy Complaint | 08/01/2014 | |
|
Download (50.5 KB) |
DCS-1051A | Request for an Accounting of Disclosures of Protected Health | 08/01/2014 | |
|
Download (44 KB) |
DCS-1042A-S | Response to HIPAA Privacy Complaint (Spanish) | 08/01/2014 | |
|
Download (52.5 KB) |
DCS-1051A-S | Request for an Accounting of Disclosures of Protected Health (Spanish) | 08/01/2014 | |
|
Download (49 KB) |
DCS-1044A | Authorization for Disclosure of Protected Health Information | 08/01/2014 | |
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Download (57 KB) |
DCS-1044A-S | Authorization for Disclosure of Protected Health Information (Spanish) | 08/01/2014 | |
|
Download (78 KB) |
DCS-1043A-S | Individual's Request for Access to Protected health Information (Spanish) | 08/01/2014 |
