Get Dpa 487 (5/07) - Request For Access To - California Department Of ...

Filling out the DPA 487 (5/07) form is an essential process for individuals seeking access to their protected health information maintained by the California Department of Social Services. This guide provides clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. In the individual information section, fill out your last name, first name, and middle initial as they appear on your identification.
3. Provide your address, including city, state, and zip code. This information is crucial for the department to verify your identity.
4. Enter your state hearing number, date of birth, and the daytime telephone number (required), along with your evening telephone number and email address.
5. In the following section, specify what type of protected health information you wish to access. Be as detailed as possible to expedite the process.
6. Select your preferred method to access the information — you have the option to request that a copy be mailed to you or to allow a person of your choosing to inspect the records.
7. If you are designating someone to inspect records, provide their name, telephone number, address, and relationship to you.
8. Attach a photocopy of your identification, indicating the type and number of the ID provided.
9. Sign and date the form, ensuring that if no identification is attached, your signature is notarized.
10. Attach any necessary address verification documents, such as a utility bill or similar proof.
11. Once all fields are completed and required documents are attached, save your changes. You can now download, print, or share the completed form as needed.

Complete your DPA 487 (5/07) form online to ensure your request for access to your protected health information is processed efficiently.