Request to Restrict Use and Disclosure of Personal Information (CDPH 6240)

Department of Public Health

This government document is issued by Department of Public Health for use in California

Add to Favorites
File Details: DOC
Downloads: 21
Source
https://www.cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/cdph6240.doc
Tags
  • Health Insurance Portability and Accountability Act
  • Health Insurance Portability and Accountability Act

Have Questions About This Form?
Ask An Expert For Help:

Questions and comments are moderated. Minimum of 10 characters.

All questions and comments are moderated and publicly viewable. Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details.

Login or sign up to submit questions