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  • Dhcs Form 6237 - Department Of Health Care Services - State Of ... - Dhcs Ca

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Please call 916 650-0490 for further information. If none of these circumstances apply please complete the form. DHCS 6237 11/07 Page 1 of 3 DAYTIME TELEPHONE NUMBER Required EVENING TELEPHONE NUMBER EMAIL ADDRESS BEST HOURS TO REACH YOU WHAT LEGAL AUTHORITY DO YOU HAVE TO REQUEST HEALTH INFORMATION OF THE INDIVIDUAL ABOVE PARENT CONSERVATOR GUARDIAN EXECUTOR OF WILL MEDICAL POWER OF ATTORNEY OTHER NOTE YOU MUST ATTACH LEGAL DOCUMENTATION TO VERI.

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​The mission of DHCS is to provide Californians with access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. Our vision is to preserve and improve the overall health and well-being of all Californians.

The CMIA is a California law that protects the confidentiality and security of individually identifiable medical information obtained by health care providers, insurers, and their contractors.

The California Consumer Privacy Act (CCPA) provides a broad exclusion for organizations handling health and medical information under HIPAA, the federal privacy law governing such information, and the Confidentiality of Medical Informatioon Act (CMIA), the California state law expanding on those protections.

Telephone Service Center: (800) 541-5555....Beneficiary questions on: Medi-Cal Eligibility. Benefits. Benefits Identification Card.

This California HIPAA release form enables patients to permit any person or 3rd party organization to have access to their personal health records. The HIPAA release form also optionally allows healthcare providers to share health information with each other.

56.10. (a) A provider of health care, health care service plan, or contractor shall not disclose medical information regarding a patient of the provider of health care or an enrollee or subscriber of a health care service plan without first obtaining an authorization, except as provided in subdivision (b) or (c).

What is CMIA? The Confidentiality of Medical Information Act (CMIA) is a California law that protects the confidentiality of individually identifiable medical information obtained by health care providers, health insurers, and their contractors.

CMIA prohibits a health care provider, health care service plan, or contractor from disclosing medical information regarding a patient, enrollee, or subscriber without first obtaining an authorization, except as specified.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232