DCS Forms

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Number Form Name Effective Date
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 CSO-1006A CSO-1006A Dentist's Certification of Medical Necessity 07/01/2014
Download CRS App Span CRS App Span Application for Enrollment into AHCCCS CRS (Spanish) 09/01/2013